Novel oral anticoagulation treatment is not associated with recurrent or severe epistaxis

Runggaldier, Daniel; Schindler, Valeria; Luo, Yongli; Kleinjung, Tobias; Soyka, Michael

doi:10.4193/rhin20.541

Cited by 4 publications

(24 citation statements)

References 11 publications

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“…The current cardiology and haematology guidelines favour DOACs over VKAs in the prevention of thromboembolic events in patients with atrial fibrillation 11 and venous thromboembolism 12 . This has created a shift towards more DOAC patients in everyday practice, a shift which has also been confirmed and reported on in the most recent papers on epistaxis patients on OACs in the ENT emergency room 7,13 .…”

Section: Objectivementioning

confidence: 72%

“…6 Studies reported the rates of posterior epistaxis 7,8,13,20,22,23 to be significantly more common in the VKA group (OR= .39, 95% CI .23 to .68, P= .001; Table 3). The heterogeneity was low (I 2 = 16.7%, 95% CI 0 to 61.5, P= .3).…”

Section: Posterior Epistaxis Meta-analysismentioning

confidence: 99%

“…The treatment is discomforting and has a huge socio-economic impact 5,6 . Up to one third of all epistaxis patients in inpatient treatment are taking oral anticoagulants (OAC) [7][8][9] . A steep rising trend in this subgroup of epistaxis patients has been noted over the past several years 10 .…”

Section: Objectivementioning

confidence: 99%

“…With regard to the rate of admission to hospital as a percentage of all patients seen in the emergency room, data was extracted from 6 studies 7,8,20,21,23,24 . No statistical significance between the groups could be found (OR= .76, 95% CI .54 to 1.07, P= .12; Table 4).…”

Section: Admission Rate Meta-analysismentioning

confidence: 99%

“…7 Studies reported on surgical intervention and/or embolization 7,8,13,[20][21][22][23] . No statistical significance between the groups could be found (OR= 1.29, 95% CI .63 to 2.66, P= .38; Table 5).…”

Section: Intervention Meta-analysismentioning

confidence: 99%

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Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis

Stankovic

Hoch²,

Rudhart³

et al. 2021

Preprint

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Objective: Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiologic and hematologic guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/Setting: A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data was analysed and standardized mean difference (SMD) was calculated according to Hedges’ g. Dichotomous data was analysed and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main Outcome/Results: A total of 8 reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to .68, P= .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion, or surgical intervention (P= .57, .12, .57 and .38 respectively) were found. Conclusion: According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

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Section: Objectivementioning

confidence: 72%

Section: Posterior Epistaxis Meta-analysismentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

Section: Admission Rate Meta-analysismentioning

confidence: 99%

Section: Intervention Meta-analysismentioning

confidence: 99%

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Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis

Stankovic

Hoch²,

Rudhart³

et al. 2021

Preprint

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Risk of inpatient epistaxis admission related to oral anticoagulation medication use

Mitchell

Workman

et al. 2023

Laryngoscope Investig Oto

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We utilized a case control study to determine if novel oral anticoagulants were associated with a higher risk of inpatient epistaxis admission. Adult patients admitted with a principal diagnosis of epistaxis in 2019–2021 were identified as well as a control group of patients matched 1:1 for age, sex, race, and medical comorbidities. For both cohorts, the presence or absence of an oral anticoagulant, classified as vitamin K inhibitors, direct oral anticoagulants (DOAC) or platelet inhibitors, was identified. 158 adult unique inpatient admissions with a principal diagnosis of epistaxis were identified. Vitamin K inhibition was present in 5.7% of cases versus 0.6% of controls (p = 0.02; OR 9.48, range 1.19‐75.77), DOACs in 4.4% of cases versus 5.1% of controls (p = 1.0) and platelet inhibitors in 2.5% of cases versus 3.8% of controls (p = 0.75). We concluded vitamin K inhibitors, compared to DOACs and platelet inhibitors, may be associated with higher likelihood of epistaxis admission.

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Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

Stankovic

Hoch

Rudhart

et al. 2021

Clinical Otolaryngology

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Objective Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiological and haematological guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/setting A systematic review and meta‐analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data were analysed and standardised mean difference (SMD) was calculated according to Hedges' g. Dichotomous data were analysed, and the Mantel‐Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main outcome/results A total of eight reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD = −0.22, 95% CI−0.42 to −0.02, p = .03) and a significantly higher rate of posterior bleeding in the VKA group (OR = .39, 95% CI 0.23 to 0.68, p = .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion or surgical intervention (p = .57, .12, .57 and .38 respectively) were found. Conclusion According to this meta‐analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

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Novel oral anticoagulation treatment is not associated with recurrent or severe epistaxis

Cited by 4 publications

References 11 publications

Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis

Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis

Risk of inpatient epistaxis admission related to oral anticoagulation medication use

Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

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