The role of oral anticoagulants in epistaxis

Abstract

PurposeThe purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants.MethodsThe study was conducted at the Department for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication.Results600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis.ConclusionOral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.

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

“…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.…”

“…like Vitamin K antagonists (VKA) is increasing [4,5]. Furthermore, new oral non-VKA oral anticoagulants (NOAC) are increasingly prescribed.…”

“…Furthermore, new oral non-VKA oral anticoagulants (NOAC) are increasingly prescribed. The increased use of classical and new anticoagulants seems to increase the incidence of epistaxis [5]. The influence on more severe epistaxis and recurrent bleeding needing inpatient treatment is less clear [3,5].…”

Approach to otolaryngology emergency in COVID-19 pandemic

“…[15] In addition, it is known that anticoagulant and thrombolytic therapy, which have entered in routine treatment of COVID-19 patients in our country [2] increase the frequency of epistaxis. [16] Epistaxis can be clinically classified as anterior and posterior bleeds. Approximately 90% of the bleeding is caused by anterior bleeds.…”

Updates on the Management of Epistaxis

“…There is also a degree of controversy regarding whether patients with thromboembolic risks presenting with a minor nosebleed or bleeding from an inaccessible site should be treated using local measures or surgical interventions. Further high-quality research will be required to resolve this issue [73,74]. At present, clinicians base their selection of treatment methods on the site and extent of bleeding, history of bleeding, the perceived likelihood of progression to more severe bleeding, comorbidities including hypertension and renal insufficiency, INR level, and the likelihood that INR has been supratherapeutic over the previous few measurements [75].…”