Warfarin and epistaxis — a case controlled study

Abstract

Patients anticoagulated with warfarin form a small proportion of thos se admitted with epistaxis annually to ENT units. The authors formed the impression that such patients spend longer in hospital and have more complicated management than controls. A prospective age and sex matched controlled study of 20 consecutive patients admitted with epistaxis whilst anticoagulated was performed. This showed thath these patients spent significantly longer in hospital than cntrols, with an additional expense in the study periold of £10,500 for impatient bed nights alone. The management of these patients is more complicated and these is a subgroup of poorly controlled patients who present most of the problems. A potentioal solution is to improve community warfarin control and to involve general practitioners and haematologist in the re-establishment of warfarin following admission for epistaxis.

Is severe epistaxis associated with acetylsalicylic acid intake?

“…Denholm et al showed that warfarin not only leads to a higher incidence but also to more complicated bleeding episodes. 15 Analogous to the latter study, we were able to demonstrate that ASA patients not only have a higher severity score in comparison with the rest of the patients, but we could also conclude that the rate of surgical intervention is even higher than in the coumarin group. There may be two explanations for this finding.…”

Risk factors for recurrent epistaxis: Importance of initial treatment

“…Tay et al indicated that patients who had been prescribed aspirin had a relative risk of hospital admission for epistaxis of between 2.17 and 2.75, depending on the control group used [14]. Denholm et al showed that patients anticoagulated with warfarin spent significantly longer in hospital than controls [24]. On the other hand, Srinivasan et al demonstrated that there was no significant difference in the mean hospital stay between the warfarin and non-warfarin groups, and warfarin can be continued x 2 = 7.09, p = 0.008. safely in patients with epistaxis, in appropriate circumstances [25].…”

Epistaxis in the setting of antithrombotic therapy: A comparison between factor Xa inhibitors, warfarin, and antiplatelet agents

“…Anticoagulation and antiplatelet therapy is associated with an increased risk of epistaxis. Previous reports have shown that antithrombotic therapy is used in up to 60% of patients admitted for epistaxis, and is associated with longer hospital stays and higher rates of readmission …”