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Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin
Author(s) -
Send Thorsten,
Bertlich Mattis,
Horlbeck Fritz,
Schafigh Darius,
Freytag Saskia,
Eichhorn Klaus W.,
Gräff Ingo,
Bootz Friedrich,
Jakob Mark
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22210
Subject(s) - medicine , rivaroxaban , vitamin k antagonist , warfarin , dabigatran , retrospective cohort study , vitamin k , culprit , prothrombin complex concentrate , oral anticoagulant , cohort , anesthesia , atrial fibrillation , myocardial infarction
Background Epistaxis is one of the more common reasons for emergency room visits. The main risk factor for epistaxis is anticoagulant therapy. Until recently, the main culprit was oral intake of a vitamin K antagonist, such as warfarin, which has a number of side effects. Even more recently, several direct oral anticoagulants, rivaroxaban and dabigatran, have been approved for use. We investigated the possible differences between treatment of epistaxis with direct oral anticoagulants and vitamin K antagonists. Methods We conducted a retrospective cohort study at a tertiary referral center in Germany. All patients who were admitted within a 1‐year period were included. Patient files were used to obtain the information. Results Overall, 677 patients were included in our study. Of these, 159 had been treated with vitamin K antagonists and 49 with direct oral anticoagulants. There were no significant differences in terms of age ( p = 0.592), sex ( p = 0.372), vital signs, bloodwork, or location of bleeding ( p = 0.372). Management of epistaxis between the groups was also comparable ( p = 0.399), with similar hospital admission rates (37.1% vs 24.5%; p = 0.145) and duration of stay (3.5 ± 2.1 days vs 3.8 ± 3.3 days; p = 0.650). Conclusion We found no evidence to suggest epistaxis is more severe or requires more invasive therapy in patients given direct oral anticoagulants. A significant proportion of patients on vitamin K antagonists were not within the target range for international normalized ratio, highlighting one of the main issues with oral anticoagulation by vitamin K antagonists.