Reduction in epistaxis and emergency department visits in patients taking warfarin after implementation of an education program

Neshewat, Julian; Wasserman, Amanda; Alexandris-Souphis, Constantina; Haymart, Brian; Feldeisen, Delaney; Kong, Xiaowen; Harvey, Rebecca S.; Pynnonen, Melissa A.; Froehlich, James B.; Kline–Rogers, Eva; Barnes, Geoffrey D.

doi:10.1016/j.thromres.2021.01.007

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Furthermore, when the CH 2 ADS 2 ‐VASc Score reaches or surpasses 7, the recurrence probability surpasses 50% in OAC epistaxis patients 13 . A recent study demonstrated that after the implementation of an education plan there were significantly less emergency department visits by epistaxis patients taking warfarin 32 . Such strategies should also be considered in DOAC patients.…”

Section: Discussionmentioning

confidence: 99%

“…13 A recent study demonstrated that after the implementation of an education plan there were significantly less emergency department visits by epistaxis patients taking warfarin. 32 Such strategies should also be considered in DOAC patients. In addition, non-medical alternatives to OACs for patients with atrial fibrillation, such as percutaneous closure of the left atrial appendage (LAA), should be examined.…”

Section: Kawabori Et Al Investigated Patterns Of Intracerebral Haemor-mentioning

confidence: 99%

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Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

Stankovic

Hoch

Rudhart

et al. 2021

Clinical Otolaryngology

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Objective Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiological and haematological guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/setting A systematic review and meta‐analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data were analysed and standardised mean difference (SMD) was calculated according to Hedges' g. Dichotomous data were analysed, and the Mantel‐Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main outcome/results A total of eight reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD = −0.22, 95% CI−0.42 to −0.02, p = .03) and a significantly higher rate of posterior bleeding in the VKA group (OR = .39, 95% CI 0.23 to 0.68, p = .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion or surgical intervention (p = .57, .12, .57 and .38 respectively) were found. Conclusion According to this meta‐analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

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Section: Discussionmentioning

confidence: 99%

Section: Kawabori Et Al Investigated Patterns Of Intracerebral Haemor-mentioning

confidence: 99%

Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

Stankovic

Hoch

Rudhart

et al. 2021

Clinical Otolaryngology

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“…This is supported by Neshewat et al ., who found that the implementation of an epistaxis educational programme for patients on warfarin led to a reduction in emergency department visits. 23…”

Section: Discussionmentioning

confidence: 99%

“…This is supported by Neshewat et al, who found that the implementation of an epistaxis educational programme for patients on warfarin led to a reduction in emergency department visits. 23 As patients are increasingly looking towards online material for knowledge regarding their condition, the understandability of health information is vital. 24 A health survey found that over 50 per cent of patients changed their perspective of a disease after performing research online.…”

Section: The Journal Of Laryngology and Otologymentioning

confidence: 99%

‘How to stop a nosebleed’: a combined objective and subjective assessment of YouTube videos on first-aid management of epistaxis

et al. 2023

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Objective A previous study in 2016 found that the quality of YouTube videos on epistaxis first-aid management was highly variable. This study aimed to reassess the accuracy and patient understandability of such YouTube videos. Method YouTube was searched using the phrase ‘How to stop a nosebleed’. The highest 50 ranking videos, based on relevance, were screened. Each video was assessed objectively using a standardised ‘advice score’, and subjectively using a video understandability and actionability checklist, the Patient Education Materials Assessment Tool for Audiovisual Materials (‘PEMAT-A/V’). Results The mean advice score was 4.1 out of 8. The mean (standard deviation) understandability and actionability scores were 76 per cent (17 per cent) and 89 per cent (18 per cent), respectively. There was a strong positive correlation between the actionability scores and the advice scores (ρ = 0.634; p < 0.001), and between the actionability scores and the understandability scores (ρ = 0.519; p = 0.002). Conclusion YouTube videos are providing increasingly relevant advice for patients seeking healthcare information. YouTube is proposed as a useful medium for teaching epistaxis management to patients and community practitioners.

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“…Although some factors are the inherent diseases and necessary drug treatment of patients which are hard to change, measures such as strengthening medication education can effectively improve the anticoagulation quality of patients. Previous studies showed that standardized medication education by pharmacists could significantly improve the quality of anticoagulation and also reduced the number of emergency admission (Verret et al, 2012;Neshewat et al, 2021). Overall, the XGBoost model is expected to be applied in practice to select patients who could benefit from active intervention to improve warfarin treatment during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Warfarin anticoagulation management during the COVID-19 pandemic: The role of internet clinic and machine learning

Dai

Zhang

et al. 2022

Front. Pharmacol.

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Background: Patients who received warfarin require constant monitoring by hospital staff. However, social distancing and stay-at-home orders, which were universally adopted strategies to avoid the spread of COVID-19, led to unprecedented challenges. This study aimed to optimize warfarin treatment during the COVID-19 pandemic by determining the role of the Internet clinic and developing a machine learning (ML) model to predict anticoagulation quality.Methods: This retrospective study enrolled patients who received warfarin treatment in the hospital anticoagulation clinic (HAC) and “Internet + Anticoagulation clinic” (IAC) of the Nanjing Drum Tower Hospital between January 2020 and September 2021. The primary outcome was the anticoagulation quality of patients, which was evaluated by both the time in therapeutic range (TTR) and international normalized ratio (INR) variability. Anticoagulation quality and incidence of adverse events were compared between HAC and IAC. Furthermore, five ML algorithms were used to develop the anticoagulation quality prediction model, and the SHAP method was introduced to rank the feature importance.Results: Totally, 241 patients were included, comprising 145 patients in the HAC group and 96 patients in the IAC group. In the HAC group and IAC group, 73.1 and 69.8% (p = 0.576) of patients achieved good anticoagulation quality, with the average TTR being 79.9 ± 20.0% and 80.6 ± 21.1%, respectively. There was no significant difference in the incidence of adverse events between the two groups. Evaluating the five ML models using the test set, the accuracy of the XGBoost model was 0.767, and the area under the receiver operating characteristic curve was 0.808, which showed the best performance. The results of the SHAP method revealed that age, education, hypertension, aspirin, and amiodarone were the top five important features associated with poor anticoagulation quality.Conclusion: The IAC contributed to a novel management method for patients who received warfarin during the COVID-19 pandemic, as effective as HAC and with a low risk of virus transmission. The XGBoost model could accurately select patients at a high risk of poor anticoagulation quality, who could benefit from active intervention.

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Reduction in epistaxis and emergency department visits in patients taking warfarin after implementation of an education program

Cited by 8 publications

References 8 publications

Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

‘How to stop a nosebleed’: a combined objective and subjective assessment of YouTube videos on first-aid management of epistaxis

Warfarin anticoagulation management during the COVID-19 pandemic: The role of internet clinic and machine learning

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