Shorter hospital stays in epistaxis patients with atrial fibrillation when taking rivaroxaban or apixaban versus phenprocoumon

Stankovic, Petar; Georgiew, R; Frommelt, C; Hammel, S; Wittlinger, Jan; Hoch, Stephan; Obradović, Danilo; Dagres, Nikolaos; Wilhelm, Thomas

doi:10.1007/s11239-019-01824-x

Cited by 9 publications

(44 citation statements)

References 20 publications

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“…The current cardiology and haematology guidelines favour DOACs over VKAs in the prevention of thromboembolic events in patients with atrial fibrillation 11 and venous thromboembolism 12 . This has created a shift towards more DOAC patients in everyday practice, a shift which has also been confirmed and reported on in the most recent papers on epistaxis patients on OACs in the ENT emergency room 7,13 .…”

Section: Objectivementioning

confidence: 73%

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Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis

Stankovic

Hoch²,

Rudhart³

et al. 2021

Preprint

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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 cardiologic and hematologic 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 was analysed and standardized mean difference (SMD) was calculated according to Hedges’ g. Dichotomous data was 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 8 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 .23 to .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: Objectivementioning

confidence: 73%

“…5 Studies reported on days in hospital and were included in the meta-analysis 13,[20][21][22][23] . A significantly longer in-hospital stay was found in the VKA group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03; Table 2).…”

Section: Days In Hospital Meta-analysismentioning

confidence: 99%

Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis

Stankovic

Hoch²,

Rudhart³

et al. 2021

Preprint

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“…Stankovic et al . 2019 showed that the majority of patients that present with epistaxis while on an anticoagulant will have a HAS‐BLED score ≥ 3 (83.7%) which are associated with morbidity and mortality 22 …”

Section: Discussionmentioning

confidence: 99%

The impact of frailty on epistaxis admission, a retrospective cohort study

Davies

Alatsatianos

Slim

et al. 2021

Clinical Otolaryngology

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Objectives Epistaxis is frequently managed with intra‐nasal packing devices, traditionally requiring patient admission. Current COVID‐19 guidelines encourage ambulatory care where possible in this patient cohort. This paper aims to establish the impact of the Clinical Frailty Scale, anticoagulant/antiplatelet therapeutics and season variation on pre‐pandemic admissions to help identify patients suitable for ambulatory epistaxis management. Design Retrospective cohort study Setting Scottish Regional Health Board Participants Adult patients attending secondary care with epistaxis between March 2019 and March 2020. Main outcome measures Likelihood of epistaxis hospital admission based on Clinical Frailty Scale. Results 299 epistaxis presentations were identified, of which 122 (40.8%) required admission. Clinical Frailty Scale of ≥4 had an increased likelihood of admission (OR 3.15 (95% CI:1.94–5.16), P < .05). In the majority of presentations (66.2%), patients were taking either an antiplatelet or anticoagulant. Of these presentations, the use of an anticoagulant (OR: 2.00 (95% CI: 1.20‐3.33), P < .05 and dual antiplatelet (OR: 2.82 (95% CI: 1.02‐7.86), P < .05) demonstrated increased likelihood of admission. Conclusions We have shown that frailty increases the risk of admission in adult patients presenting with epistaxis. Clinical Frailty Scale (CFS) could be utilised in risk stratification to identify suitable patients for outpatient management. Patients with CFS ≤ 3 could be considered for outpatient management of their epistaxis. It is likely that patients with CFS ≥4 on anticoagulant or dual antiplatelet will require admission.

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“…34 That hypertension and DOAC use explain only a small portion of the geographic variation of epistaxis procedures among Medicare patients may be because patients taking DOAC are more likely to experience anterior rather than posterior bleeds, which can often be managed with conservative measures that do not have associated CPT codes. 7,34 It is also possible that the high prevalence of hypertension and DOAC use among elderly patients in general obscures small differences between states and makes the correlation between these risk factors and epistaxis less apparent. 35,36 Additionally, other risk factors not specifically investigated by our study may play a larger role in the geographical variation of epistaxis procedures.…”

Section: Discussionmentioning

confidence: 99%

“…7 Moreover, a study by Stankovic et al found that patients taking DOAC medications had higher rates of anterior epistaxis requiring electrocautery and nasal packing compared with patients taking vitamin K antagonists. 34 That hypertension and DOAC use explain only a small portion of the geographic variation of epistaxis procedures among Medicare patients may be because patients taking DOAC are more likely to experience anterior rather than posterior bleeds, which can often be managed with conservative measures that do not have associated CPT codes. 7,34 It is also possible that the high prevalence of hypertension and DOAC use among elderly patients in general obscures small differences between states and makes the correlation between these risk factors and epistaxis less apparent.…”

Section: Discussionmentioning

confidence: 99%

Geographic Variation in Epistaxis Interventions Among Medicare Beneficiaries

Hur

Badash

Talmor

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: To quantify the utilization of epistaxis procedures in the elderly population and assess whether the geographic variability of these procedures is associated with hypertension and direct oral anticoagulant (DOAC) use. Methods: A cross-sectional study was performed on publicly available Medicare procedure and beneficiary data from 2013 to 2016 for all epistaxis procedures categorized by Common Procedural Terminology (CPT). Epistaxis procedures were analyzed by state, complexity, and provider type. Pearson’s correlation coefficient was calculated. Results: Over 4 years, 2 19 827 epistaxis procedures were performed on Medicare patients, 44.3% of which were categorized as simple (control of nasal hemorrhage: anterior simple or posterior primary). Otolaryngologists performed 92.6% of all epistaxis procedures. The frequency of epistaxis procedures performed by state ranged from 0.99 procedures per 10 000 Medicare beneficiaries (PP10K) in Hawaii to 25.7 PP10K in New Jersey. The percentage of epistaxis interventions categorized as complex (anterior complex, posterior subsequent, with nasal endoscopy, or open procedures) in each state varied from 0% in North Dakota to 72.6% in Hawaii. Epistaxis procedure utilization was weakly correlated with the prevalence of hypertension ( R2 = 0.08, P = .04) and higher percentage of DOAC among all anticoagulants prescribed ( R2 = 0.08, P = .04) in a state’s Medicare population. Utilization of complex epistaxis interventions was not correlated with the prevalence of hypertension or DOAC use. Conclusions: Otolaryngologists perform the vast majority of epistaxis procedures in the Medicare population. However, practice patterns vary across the United States. Hypertension and DOAC use are weakly associated with the utilization of epistaxis interventions.

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Shorter hospital stays in epistaxis patients with atrial fibrillation when taking rivaroxaban or apixaban versus phenprocoumon

Cited by 9 publications

References 20 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

The impact of frailty on epistaxis admission, a retrospective cohort study

Geographic Variation in Epistaxis Interventions Among Medicare Beneficiaries

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