Management of epistaxis in patients on novel oral anticoagulation therapy

Abstract

BackgroundIndividuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy.ObjectiveThis paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management.MethodA comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019.ResultsPatients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined.ConclusionClinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.

Epistaxis in dental and maxillofacial practice: a comprehensive review

“…The authors reported that it is safe to perform most dental practices in patients taking these anticoagulants regardless of the anticoagulant's discontinuance duration; however, they postulated that dental and maxillofacial procedures requiring graft and osteotomy need at least 24 hours of discontinuance 47 . In cases of severe epistaxis, attempts to reverse anticoagulation or to cease anticoagulant therapy should be considered 48 . Idarucizumab is an antibody antigen-binding fragment that completely reverses the anticoagulant effect within minutes of administration 48 .…”

“…In cases of severe epistaxis, attempts to reverse anticoagulation or to cease anticoagulant therapy should be considered 48 . Idarucizumab is an antibody antigen-binding fragment that completely reverses the anticoagulant effect within minutes of administration 48 .…”

“…Dentists need to be informed of the potential severity of epistaxis and the increased likelihood of recurrence in patients taking oral anticoagulation therapy who are undergoing dental or maxillofacial interventions. Preoperative involvement of the hematologist and cardiologist is usually necessary to modify drug dosage 48 .…”

Etiological factors of resistant epistaxis and their effects on treatment outcomes

“…Antikoagülan kullanımı epistaksis için birçok yayında risk faktörü olarak tanımlanmıştır. [31][32][33] Bizim çalışmamızda AK kullanımı %26 olarak hesaplandı ve AK kullanımı ile hastanede yatış süresi arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Gomes ve ark.…”

Virtual issue: ENT care of older adults

“…Nose bleeds (epistaxis) in older adults have always been associated with significant mortality, often related to associated co-morbidities and the deleterious effects on the cardio-respiratory system of nasal packing and bed rest. 31,32 This difficult problem has been rendered even more difficult by the rise in prescriptions for anticoagulant agents, 33 particularly the newer oral anticoagulants (‘NOACs’).…”