All of the following have a causative association with primary epistaxis in an elderly patient except:

Factors associated with Primary adult Epistaxis: 1. CHRONOBIOLOGY The frequency of admission is greatest in the autumn and winter months.This seasonal variation correlates with fluctuations in environmental temperature and humidity. A chronobiological rhythm is also observed at the circadian level where onset of bleeding and hospital admission show a biphasic pattern with peaks in the morning and late evening. 2. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAID): The action of non-steroidal anti-inflammatory drugs is mediated an anti-platelet aggregation effect due to altered platelet membrane physiology. 3. ALCOHOL Epistaxis patients are more likely to have consumed alcohol within 24 hours. The use of alcohol by epistaxis patients is associated with a prolongation of the bleeding time despite normal platelet counts and coagulation factor activity. HYPEENSION (NOT A Causative Factor) This has long been considered a cause of epistaxis. However,a number of large studies have failed to show a causal relationship between hypeension and epistaxis. The apparent hypeension in acute admissions of epistaxis may be a result of anxiety associated with hospital admission and the invasive techniques used to control the bleeding.