Epistaxis complicated by rivaroxaban managed with topical tranexamic acid

Utkewicz, Mark D.; Brunetti, Luigi; Awad, Nadia I.

doi:10.1016/j.ajem.2015.02.049

Cited by 5 publications

(5 citation statements)

References 18 publications

(9 reference statements)

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“…However, a recent review of epistaxis patients found a lack of studies including patients treated with DOAC and could not identify a direct comparison of patients under DOAC or VKAs . Only a few case reports about the management of patients with epistaxis on DOAC therapy exist . Although severe bleeding complications in DOAC patients are rare, epistaxis was found to be one of the most frequent minor bleeding complication in patients on DOAC therapy …”

Section: Introductionmentioning

confidence: 99%

“…2 Only a few case reports about the management of patients with epistaxis on DOAC therapy exist. 6,7 Although severe bleeding complications in DOAC patients are rare, epistaxis was found to be one of the most frequent minor bleeding complication in patients on DOAC therapy. 8 To our knowledge, no study has yet described the characteristics of ED patients with epistaxis during DOAC therapy, nor did we find a direct comparison of DOACs and VKAs in patients presenting with epistaxis.…”

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confidence: 99%

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Epistaxis in anticoagulated patients: Fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon

Sauter

Hegazy

Hautz

et al. 2017

Clinical Otolaryngology

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Objectives: Treatment of epistaxis in patients on anticoagulants is challenging and associated with higher admission rates and longer hospital stays compared with patients without anticoagulation. However, there is little information about epistaxis in patients taking new direct oral anticoagulants such as rivaroxaban compared with patients on traditional vitamin K antagonists such as phenprocoumon.Design: Retrospective cohort study. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Epistaxis in anticoagulated patients: Fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon

Sauter

Hegazy

Hautz

et al. 2017

Clinical Otolaryngology

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“…Tranexamic acid inhibits the binding of plasminogen to fibrin, thereby preventing clot breakdown. 12,13,28 There is no standard classification for the severity of bleeding, and it may vary from patient to patient. Specific treatment depends on the involved artery, and the correct identification of the bleeding artery is the most basic measure for an effective treatment.…”

Section: Discussionmentioning

confidence: 99%

What is the Best Management for Geriatric Epistaxis? A Comprehensive Systematic Review and Meta-analysis

Shahsavarinia,

Faridaalaee,

Eisazadeh Ahranjani

et al. 2023

Int J Drug Res Clin

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Background: Given the importance of epistaxis in elder patients, this systematic review was conducted to determine the best non-surgical treatment of epistaxis in elder patients. Methods: A systematic search of references was performed to investigate non-surgical methods in administering epistaxis in elder people in March 2022 for relevant articles. Results: Among 1613 retrieved articles in the initial search, 28 studies were included, and the mean re-bleeding in 18 studies was 18%. Regarding the treatment methods, 35.7%, 14.3%, 10.7%, and 10.7% used nasal packing, intranasal topical tranexamic acid, silver nitrate, and Floseal® treatment, respectively. The highest success rate was related to topical tranexamic acid compared to topical oxymetazoline spray (Odds ratio [OR]: 6.50, 95% confidence interval [CI]: 1.54-27.49, P=0.011), followed by nasal compression with tranexamic acid compared to the placebo. Conclusion: It seems that tranexamic acid has a beneficial effect on controlling epistaxis in the elderly. However, well-designed large randomized controlled trials are indicated for an accurate conclusion.

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“…Patients should also be assessed for any new interacting medications that may increase DOAC levels. Several case reports of epistaxis in patients taking dabigatran or rivaroxaban have been published, 61-66 but the management strategies employed were variable (including temporarily or permanently stopping the DOAC, changing the DOAC to a vitamin K antagonist or using topical tranexamic acid), offering little insight into general recommendations.…”

Section: Managementmentioning

confidence: 99%