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

Yaniv, Dan; Zavdy, Ofir; Sapir, Einav; Levi, Lirit; Soudry, Ethan

doi:10.1002/lary.29417

Cited by 12 publications

(40 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 Studies reported the rates of posterior epistaxis 7,8,13,20,22,23 to be significantly more common in the VKA group (OR= .39, 95% CI .23 to .68, P= .001; Table 3). The heterogeneity was low (I 2 = 16.7%, 95% CI 0 to 61.5, P= .3).…”

Section: Posterior Epistaxis Meta-analysismentioning

confidence: 99%

“…The treatment is discomforting and has a huge socio-economic impact 5,6 . Up to one third of all epistaxis patients in inpatient treatment are taking oral anticoagulants (OAC) [7][8][9] . A steep rising trend in this subgroup of epistaxis patients has been noted over the past several years 10 .…”

Section: Objectivementioning

confidence: 99%

“…With regard to the rate of admission to hospital as a percentage of all patients seen in the emergency room, data was extracted from 6 studies 7,8,20,21,23,24 . No statistical significance between the groups could be found (OR= .76, 95% CI .54 to 1.07, P= .12; Table 4).…”

Section: Admission Rate Meta-analysismentioning

confidence: 99%

“…7 Studies reported on surgical intervention and/or embolization 7,8,13,[20][21][22][23] . No statistical significance between the groups could be found (OR= 1.29, 95% CI .63 to 2.66, P= .38; Table 5).…”

Section: Intervention Meta-analysismentioning

confidence: 99%

“…The recurrence rates were noted in 5 studies 7,8,13,21,22 . The rates were comparable between the groups with no statistically significant difference (OR= 1.13, 95% CI .75 to 1.7, P= .57; Table 6).…”

Section: Recurrence Rate Meta-analysismentioning

confidence: 99%

See 4 more Smart Citations

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

Stankovic

Hoch²,

Rudhart³

et al. 2021

Preprint

View full text Add to dashboard Cite

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.

show abstract

Section: Posterior Epistaxis Meta-analysismentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

Section: Admission Rate Meta-analysismentioning

confidence: 99%

Section: Intervention Meta-analysismentioning

confidence: 99%

Section: Recurrence Rate Meta-analysismentioning

confidence: 99%

See 3 more Smart Citations

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

Stankovic

Hoch²,

Rudhart³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

The pattern of epistaxis recurrence in patients taking prophylactic acetylsalicylic acid (ASA) from a 10 year cohort

Stankovic

Hoch

Rudhart

et al. 2022

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Objectives Epistaxis is the most common otolaryngological emergency and one-third of epistaxis patients regularly take low-dose acetylsalicylic acid (ASA) for the prevention of cardiovascular disease (CVD). The shift in contemporary guidelines identifies little benefit of ASA intake in patients who have not previously had an infarction. Existing evidence confirms ASA intake as a factor for severe epistaxis, while the evidence concerning its impact on recurrence is ambiguous. There are no available studies which justify the administration of these drugs nor are there any studies correlating the effects of these drugs to the SCORE2 CVD risk stratifying scale. Study design A retrospective analysis of all admitted epistaxis patients in a tertiary academic hospital for the 10 year period 2011 to 2021. Methods Patient data were analysed using the hospital information software. A recurrence was defined as an epistaxis episode requiring hospital readmittance for at least one night. Patients taking anticoagulants were excluded (N = 421). Results 444 patients were included: 246 were taking ASA and 198 were not (NoASA). ASA patients had more frequent recurrence in general (p = 0.03), more recurrences per patient (p = 0.002), and more changes in bleeding localisation (p = 0.04). Recurrence in the ASA group was associated with lower haemoglobin values (HR 0.62, p < 0.0001), while surgery (HR 6.83, p < 0.0001) was associated with recurrence in the NoASA group. ASA patients had a statistically significant (r 0.33, p = 0.032) correlation between the total number of epistaxis recurrences and SCORE2. The indication for drug intake was highly questionable in as much as 40% of ASA patients. Follow-up time was 5.27 years. Conclusions Epistaxis patients taking prophylactic ASA are significantly more burdened by recurrence, because they have more frequent recurrences, a greater number of recurrences per patient, and more changes in bleeding localisations when compared to control patients. The drug indication is questionable in up to 40% of ASA patients, exposing them unnecessarily to recurrence. Level of evidence 4.

show abstract

Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society

Koskinas,

Terzis,

Georgalas

et al. 2023

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible—even unethical—to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach. Methods A review of the literature was performed using PubMed Database and search terms included “posterior epistaxis”, “treatment”, “management”, “guidelines”, “algorithm” “nasal packing”, “posterior packing”, “surgery”, “SPA ligation”, “embolization”, “risk factors” or a combination of the above. Results Initial patients’ assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions. Conclusion Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies. Graphical abstract

show abstract

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

Cited by 12 publications

References 21 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 pattern of epistaxis recurrence in patients taking prophylactic acetylsalicylic acid (ASA) from a 10 year cohort

Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society

Contact Info

Product

Resources

About