Epistaxis in anticoagulated patients: Fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon

Abstract

Objectives: Treatment of epistaxis in patients on anticoagulants is challenging and associated with higher admission rates and longer hospital stays compared with patients without anticoagulation. However, there is little information about epistaxis in patients taking new direct oral anticoagulants such as rivaroxaban compared with patients on traditional vitamin K antagonists such as phenprocoumon.Design: Retrospective cohort study. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Characteristics, treatment and outcome of bleeding after tooth extraction in patients on DOAC and phenprocoumon compared to non-anticoagulated patients—a retrospective study of emergency department consultations

“…As regards outcome parameters, there were no differences between the group with respect to the number of hospital admissions and length of hospitalisation. Real-life data, also including economical considerations in connection with bleeding events, are emerging on anticoagulation and the newer DOACs [15]. Those studies may influence the choice of a specific anticoagulant medication.…”

Current Approaches to Epistaxis Treatment in Primary and Secondary Care

“…Hospital stay was longer for dabigatran patients, however, because the lack of an easily available coagulation test and persistent oozing after removal of packing made it necessary to keep the patients under continued observation (25). One retrospective study of epistaxis in patients taking rivaroxaban showed a lower percentage of inpatient admissions (10.4% versus 18.0%, p = 0.033) and shorter hospital stay (0.7 ± 2.2 versus 1.5 ± 3.7 days, p = 0.011) in comparison to patients taking vitamin K antagonists (26). Another risk factor identified was alcohol (14)(15)(16).…”

Updates on the Management of Epistaxis

“…A number of drugs such as warfarin, dipyridamole, rivaroxaban, and nonsteroidal anti-inflammatory drugs (NSAIDs) can affect blood coagulation [1,29,40,68]. NSAIDs, including aspirin and ibuprofen, are the most common drugs that may interfere with coagulation [45]; however, researchers have yet to establish a definitive causal association between the use of NSAIDs and epistaxis [69][70][71].…”

“…It has been estimated that 24% to 33% of patients admitted for nosebleeds are taking anticoagulants or antiplatelet medications [2]. Vitamin K antagonists, such as phenprocoumon, have also been shown to contribute to recurrent epistaxis [68,72]. It has been reported that specific serotonin reuptake inhibitors and antibiotics can induce epistaxis; however, most of those bleeding episodes are mild and easily reversed [1].…”

“…Minor events are easily managed in a clinical environment; however, major events often require hospital admission and even surgical intervention. In the event that the patient does not respond to initial treatment, efforts must be made to find the cause of the bleeding [6,68,83]. Children must be examined closely for a foreign body or nasal mass to ensure that epistaxis is benign [84].…”