Abstract
PurposeThe purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants.MethodsThe study was conducted at the Department for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication.Results600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis.ConclusionOral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.
Highlights
Epistaxis is common and occurs with a lifetime prevalence of 60% [1]
The working hypothesis of this study was that patients with a preexisting medication of oral anticoagulants experience more often complications or have more serious disease courses when presenting with epistaxis at the ENT emergency service
This study will attempt to address whether new oral anticoagulants lead to more severe or prolonged bleedings compared to classic oral anticoagulants
Summary
Epistaxis is common and occurs with a lifetime prevalence of 60% [1]. Even though only 6–10% of nosebleeds require the treatment of a doctor, it is, along with pharyngitis, the most common cause for ear–nose–throat (ENT) emergency visits [2, 3]. About 1.6/10,000 patients need to be admitted to the ward [1]. Depending on the localization of the bleeding, ENT doctors differentiate anterior (90%) from posterior (6–10%) epistaxis [4].
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