Bleeding from varicose veins
We read with interest the paper by Bradbury et al investigating the
symptoms of varicose veins1, but were surprised that there was no mention
of the problem of external haemorrhage. Bleeding from varicose veins may
spontaneous or follow minor trauma and may be significant2-4. In a study
co-ordinated by the Scottish Trauma Audit Group of traumatic deaths in
1995 in the city of Glasgow, there were three deaths resulting from
haemorrhage from varicose veins. The three individuals were elderly (aged
71 - 80 years), lived alone and were found dead at home, having
exsanguinated from a varicose vein on the lower leg. One of the three
knocked her leg against furniture, called an ambulance, but was found by
the ambulance crew in cardiac arrest amid copious haemorrhage. The other
two individuals were found dead having bled externally from a varicose
vein - in one case, blood was found on the edge of a kitchen unit,
implying that the vein may have been knocked against it; in the other
case, no blood was found on any furniture - the haemorrhage may have been
spontaneous. The risk of serious haemorrhage needs to be taken into
consideration by those treating patients with varicose veins. Deaths
following spontaneous haemorrhage or minor trauma to varicose veins are
potentially preventable using simple first aid measures. Patients should
be routinely advised that if bleeding occurs, they should apply direct
pressure to the bleeding point, call for help, then
continue to apply pressure until that help arrives. This advice needs to
be particularly targeted to elderly individuals who may tolerate
haemorrhage poorly and therefore appear to be at particular risk2,3.
1 Bradbury A, Evans C, Allan P, Lee A, Ruckley CV, Fowkes FGR. What
are the symptoms of varicose veins? Edinburgh vein cross sectional
population survey. BMJ 1999;318:353-6.
2 Morrow PL, Hardin NJ, Karn CM, Beloin R, McDowell RW.
Fatal hemorrhage caused by varicose veins. Am J Forensic Med Pathol 1994;
3 Evans GA, Seal RME, Evans DND, Craven JL.
Spontaneous fatal haemorrhage caused by varicose veins.
Lancet 1973; 1: 1359-60.
4 Wigle RL, Anderson GV.
Exsanguinating hemorrhage from peripheral varicosities.
Ann Emerg Med 1988; 17: 135-7.
Accident and Emergency
Cornwall TR1 3LJ
Scottish Trauma Audit Group
Accident and Emergency
Forensic Medicine Unit
Competing interests: No competing interests