Severe spontaneous epistaxis: retrospective study in a tertiary ENT centre

Marin, Eline; Watelet, Jean-Baptiste; Gevaert, Philippe; Zele, Thibaut Van

doi:10.1007/s00405-019-05392-x

Cited by 13 publications

(13 citation statements)

References 40 publications

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“…Furthermore, the risk for severe epistaxis in the ACAP group was significantly higher (OR = 1.8, P < .05) than the control group. Previous studies demonstrate that the typical pattern of patients being hospitalized for severe epistaxis is male gender, middle to advanced age, displaying some underlying comorbidity, taking medication affecting coagulation, and presenting with a posterior epistaxis 16,17 . Interestingly, ACAP medications were not associated with an increased risk for epistaxis recurrence over an average follow up time of 2.7 years.…”

Section: Discussionmentioning

confidence: 94%

The Impact of Traditional Anticoagulants, Novel Anticoagulants, and Antiplatelets on Epistaxis

et al. 2021

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Objective/Hypothesis Anticoagulant and antiplatelet medications (ACAP) are known to be associated with an increased risk for epistaxis. There are conflicting results regarding the impact of Novel Oral Anticoagulants (NOAC) on epistaxis and its severity. Study Design Retrospective chart review of patients who were admitted to the ED in our tertiary level hospital with a diagnosis of epistaxis during the years 2012 to 2018. Methods Retrospective analysis of patients presenting to tertiary level emergency otolaryngological care during the years 2012 to 2018. The impact of various ACAP medications on epistaxis severity, hospital admission, and recurrence was analyzed. Results A total of 470 patients were identified. Two hundred and twenty‐nine patients (49%), were not on any anticoagulant/antiplatelet (ACAP) medications (controls) and 241 patients (51%) were taking at least one ACAP medication (ACAP group). Patients in the ACAP group were at a higher risk for severe epistaxis (OR = 1.8, P < .05) and were more likely to be hospitalized (OR = 2.17, P < .05). Surprisingly, the risk for recurrence was similar in the ACAP and control groups (15%, P > .05). Compared to controls, Warfarin and Enoxaparin increased the overall risk for severe epistaxis (OR = 4.4, P < .05) and for hospital admission (OR = 2.1, P < .05). Specifically, an increased risk for posterior tamponade (OR = 19, P < .001), significant blood loss (OR = 4.4, P = .032), and blood transfusion (OR = 4.7, P = .007) were identified as well. Interestingly, NOACs were not associated with increased risk for severe epistaxis, hospital admission, tamponade, and significant blood loss or blood transfusion compared to controls. Conclusions Compared to older generation anticoagulants and antiplatelet medications, NOACs demonstrated an improved safety profile, in terms of epistaxis severity, need for hospital admission and outcomes. These results may suggest a more conservative approach and less hospitalization when treating epistaxis in patients receiving NOACs. Level of Evidence 4 Laryngoscope, 131:1946–1951, 2021

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Section: Discussionmentioning

confidence: 94%

The Impact of Traditional Anticoagulants, Novel Anticoagulants, and Antiplatelets on Epistaxis

et al. 2021

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“… 10 The epistaxis study of Marin et al thought that research needed to accurately investigate the role played by underlying diseases and their treatment in the occurrence of epistaxis. 11 Therefore, in order to prevent the recurrence of intractable epistaxis, accurate searching of the bleeding site under the “map” of intractable epistaxis and minimally invasive hemostasis is required. Leveraging on the mapping of the bleeding site, this study further analyzed the related risk factors of intractable epistaxis, and their association with the mapped bleeding sites, in hopes of providing assistance to community family doctors in the treatment of intractable epistaxis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Bleeding Site to Identify Associated Risk Factors of Intractable Epistaxis

Liao

Guo

et al. 2021

TCRM

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Introduction Intractable epistaxis refers to deep occult bleeding and uncontrolled persistent bleeding. Effective treatment can only be implemented if the bleeding site is quickly identified and the underlying disease controlled. Objective The relationship between the bleeding site and the pathogenic factors of intractable epistaxis was analyzed to further strengthen the prevention and treatment of intractable epistaxis by outpatient doctors, family doctors and otolaryngologists. Through accurate search and minimally invasive hemostasis, it helped optimize the treatment plan for intractable epistaxis. Methods This study retrospectively analyzed the clinical data of 90 patients with intractable epistaxis who were admitted to hospital from January 2016 to December 2017. Chi-square test was used to analyze the relationship between intractable epistaxis site with underlying disease, gender and age. Results The distribution of intractable epistaxis was associated with hypertension ( χ 2 =13.76, P =0.017). The incidence of hypertension was the highest in the olfactory sulcus of the middle turbinate region at about 60%. In addition, age was also identified as a factor that affects the distribution of intractable epistaxis ( χ 2 =21.95, P =0.02). The incidence of intractable epistaxis on the vault of inferiornasal meatus region was highest (63%) in young patients. On the other hand, the olfactory sulcus of the middle turbinate region accounted for the highest incidence in the middle-aged and elderly group (66.7%). There was no obvious relation between the bleeding site of intractable epistaxis with diabetes, cardiovascular disease, chronic sinusitis and allergic rhinitis. Conclusion The bleeding site of intractable epistaxis is related to hypertension and age. This may improve the identification of the site of intractable epistaxis for timely implementation of treatment and can further strengthen the prevention and treatment of intractable epistaxis in outpatients or family doctors.

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“…Others have also shown a male predominance, cardiovascular disease as frequent comorbidity, and overpresentation of patients with anti-platelet drug and anticoagulant use [3,5,7,8,17,18]. Data on duration of admission are sparse.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization for epistaxis: a population-based healthcare research study in Thuringia, Germany

Kallenbach

Dittberner

Boeger

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Epistaxis is the most common ENT emergency. The aim was to determine population-based data on severe epistaxis needing inpatient treatment. Methods Retrospective population-based cohort study in the federal state Thuringia in 2016 performed on all 840 inpatients treated for epistaxis in otolaryngology departments (60.1% male, median age: 73 years; 63.9% under anticoagulation). The association between patients' and treatment characteristics and longer inpatient stay (≥ 4 days) as well as readmission for recurrent epistaxis was analyzed using univariable and multivariable statistics. Results The overall incidence of epistaxis needing inpatient treatment was higher for men (42 per 100,000) than for women (28 per 100,000). The highest incidence was reached for men > 85 years (222 per 100,000). Most important independent predictors for longer inpatient stay were localization of the bleeding not in the anterior nose (OR = 2.045; CI = 1.534-2.726), recurrent bleeding during inpatient treatment (OR = 2.142; CI = 1.508-3.042), no electrocoagulation (OR = 2.810; CI = 2.047-3.858), and blood transfusion (OR = 2.731; CI = 1.324-5.635). Independent predictors for later readmission because of recurrent epistaxis were male gender (OR = 1.756; CI = 1.155-2.668), oral anticoagulant use (OR = 1.731; CI = 1.046-2.865), and hereditary hemorrhagic telangiectasia (OR = 13.216; CI 5.102-34.231). Conclusions Inpatient treatment of epistaxis seems to be variable in daily routine needing standardization by clinical guidelines and strategies to shorten inpatient treatment and to reduce the risk of readmission.

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Severe spontaneous epistaxis: retrospective study in a tertiary ENT centre

Cited by 13 publications

References 40 publications

The Impact of Traditional Anticoagulants, Novel Anticoagulants, and Antiplatelets on Epistaxis

The Impact of Traditional Anticoagulants, Novel Anticoagulants, and Antiplatelets on Epistaxis

Analysis of Bleeding Site to Identify Associated Risk Factors of Intractable Epistaxis

Hospitalization for epistaxis: a population-based healthcare research study in Thuringia, Germany

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