Management of epistaxis in patients with anti-thrombotic therapy
Abstract Introduction and objective: epistaxis is one of the most frequent otorhinolaryngological emergencies. One of its causes is alterations in hemostasis caused by anti-thrombotic therapy. The aim of the study is to determine if there are differences in the management of epistaxis between patients with anti-thrombotic therapy and control patients. Method: retrospective analytical observational study of patients admitted to the Otorhinolaryngology service of a tertiary hospital, between January 2010 and December 2016. Epidemiological, clinical and therapeutic characteristics of the patients have been collected through their electronic medical records and comparative statistical analysis was performed between patients with anti-thrombotic therapy and control patients. Results: a total of 85 patients (74.1% male) were analyzed. Mean age at diagnosis of 66.7 years. 49.4% were undergoing anti-thrombotic therapy. Anterior nasal packing was performed in all patients and posterior nasal packing in 16 patients. 37 patients required endoscopic nasal surgery. Embolization was performed in four patients. In the comparative statistical study, no statistically significant differences were found between both groups in any of the variables analyzed. Discussion and conclusions: the current indications for anti-thrombotic therapy are very broad and therefore it is common to treat epistaxis in this type of patient. Although it has not been clearly demonstrated that anti-thrombotic therapy alone is associated with more serious bleeding, we believe that multidisciplinary management of these patients is essential in order to achieve adequate control of bleeding without the need for more aggressive interventions.
- Referencias
- Cómo citar
- Del mismo autor
- Métricas
1. Ramírez-Sabio J, De Paula-Berneta C, Marco Algarra J. Epistaxis. En: Suárez C, Gil-Carcedo, LM, Marco J, Medina J, Ortega P, Trinidad J. Tratado de Otorrinolaringología y Cirugía de Cabeza y Cuello. 2ª ed. Madrid: Editorial Médica Panamericana; 2007. p. 637-35.
2. Rudmik L, Smith T. Management of intractable spontaneous epistaxis. Am J Rhinol Allergy. 2012; 26(1):55-60.
3. Villwock JA, Jones K. Recent trends in epistaxis management in the United States. 2008-2010. JAMA Otolaryngol Head Neck Surg. 2013;139(12):1279-84.
4. Yau, S. An update on epistaxis. Aust Fam Physician. 2015;44(9):653-6.
5. Musgrave KM, Powell J. A systematic review of anti-thrombotic therapy in epistaxis. Rhinology. 2016;54(4):292-391.
6. Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2011;125(01):38-42.
7. García-Cabo P, Fernández-Vañes L, Pedregal D, Menéndez Del Castro M, Murias E, Vega P, Llorente JL, Rodrigo JP, López F. Manejo de las epistaxis graves yo refractarias. Acta Otorrinolaringol Esp. 2019;70(4):185-91.
8. Gomes P, Salvador P, Lombo C, Caselhos S, Fonseca R. Role of age and anticoagulants in recurrent idiopathic epistaxis. Acta Otorrinolaringol Esp. 2019 Sep 11. pii: S0001-6519(19)30119-0. [Epub ahead of print].
9. Vaamonde-Lago P, Martín-Martín C, Cajade-Frías J, Mínguez-Beltrán I, Lechuga-García MR, Frade-González C, Bartual-Magro J, Labella-Caballero T. Datos epidemiológicos sobre la epistaxis: estudio hospitalario y revisión de la literatura. Acta Otorrinolaringol. Gallega 2003;4:1-8. ISSN-e 2340-3438.
10. Boned-Ombuena A, Pérez-Panadés J, López-Maside A, Miralles-Espí M, Guardiola Vilarroig S, Adam Ruiz D, Zurriaga O. Prevalencia de la anticoagulación oral y calidad de su seguimiento en el ámbito de la atención primaria: estudio de la Red Centinela Sanitaria de la Comunitat Valenciana. Aten Primaria. 2017;49(9):534-48.
11. Navarro JL, Cesar JM, Fernández MA, Fontcuberta J, Reverter JC, Gol-Freixa J. Morbilidad y mortalidad en pacientes con tratamiento anticoagulante oral. Rev Esp Cardiol. 2007;60(12):1226-32.
12. Srinivasan V, Patel H, John DG, Worsley A. Warfarin and epistaxis: should warfarin always be discontinued? Clin Otolaryngol Allied Sci. 1997;22(6):542-4.
13. Buchberger AMS, Baumann A, Johnson F, Peters N, Piontek G, Storck K, Pickhard A. The role of oral anticoagulants in epistaxis. Eur Arch Otorhinolaryngol. 2018;275(8):2035-43.
14. Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2011;125(1):38-42.
15. García Callejo FJ, Bécares Martínez C, Calvo González J, Martínez Beneyto P, Marco Sanz M, Marco Algarra J. Epistaxis y dabigatrán, nuevo anticoagulante oral no antagonista de la vitamina K. Acta Otorrinolaringológica Esp. 2014;65(6):346-54.
16. Glikson E, Chavkin U, Madgar O, Sagiv D, Nakache G, Yakirevitch A, Wolf M, Alon E. Epistaxis in the setting of antithrombotic therapy: a comparison between factor Xa inhibitors, warfarin, and antiplatelet agents. Laryngoscope. 2019; 129(1):119–23.
17. L’Huillier V, Badet C, Tavernier L. Epistaxis complicating treatment by anti-vitamin K and new oral anticoagulants. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(4):231-5.
18. Sauter TC, Hegazy K, Hautz WE, Krummrey G, Ricklin ME, Nagler M, Borner U, Exadaktylos AK. Epistaxis in anticoagulated patients: fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon. Clin Otolaryngol. 2018;43(1):103-8.
19. Send T, Bertlich M, Horlbeck F, Schafigh D, Freytag S, Eichhorn KW, Gräff I, Bootz F, Jakob M. Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin. Int Forum Allergy Rhinol. 2019;9(1):120-124.
20. Mateo J. Nuevos anticoagulantes orales y su papel en la práctica clínica. Rev Esp Cardiol Supl. 2013;13(3):33-41.
2. Rudmik L, Smith T. Management of intractable spontaneous epistaxis. Am J Rhinol Allergy. 2012; 26(1):55-60.
3. Villwock JA, Jones K. Recent trends in epistaxis management in the United States. 2008-2010. JAMA Otolaryngol Head Neck Surg. 2013;139(12):1279-84.
4. Yau, S. An update on epistaxis. Aust Fam Physician. 2015;44(9):653-6.
5. Musgrave KM, Powell J. A systematic review of anti-thrombotic therapy in epistaxis. Rhinology. 2016;54(4):292-391.
6. Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2011;125(01):38-42.
7. García-Cabo P, Fernández-Vañes L, Pedregal D, Menéndez Del Castro M, Murias E, Vega P, Llorente JL, Rodrigo JP, López F. Manejo de las epistaxis graves yo refractarias. Acta Otorrinolaringol Esp. 2019;70(4):185-91.
8. Gomes P, Salvador P, Lombo C, Caselhos S, Fonseca R. Role of age and anticoagulants in recurrent idiopathic epistaxis. Acta Otorrinolaringol Esp. 2019 Sep 11. pii: S0001-6519(19)30119-0. [Epub ahead of print].
9. Vaamonde-Lago P, Martín-Martín C, Cajade-Frías J, Mínguez-Beltrán I, Lechuga-García MR, Frade-González C, Bartual-Magro J, Labella-Caballero T. Datos epidemiológicos sobre la epistaxis: estudio hospitalario y revisión de la literatura. Acta Otorrinolaringol. Gallega 2003;4:1-8. ISSN-e 2340-3438.
10. Boned-Ombuena A, Pérez-Panadés J, López-Maside A, Miralles-Espí M, Guardiola Vilarroig S, Adam Ruiz D, Zurriaga O. Prevalencia de la anticoagulación oral y calidad de su seguimiento en el ámbito de la atención primaria: estudio de la Red Centinela Sanitaria de la Comunitat Valenciana. Aten Primaria. 2017;49(9):534-48.
11. Navarro JL, Cesar JM, Fernández MA, Fontcuberta J, Reverter JC, Gol-Freixa J. Morbilidad y mortalidad en pacientes con tratamiento anticoagulante oral. Rev Esp Cardiol. 2007;60(12):1226-32.
12. Srinivasan V, Patel H, John DG, Worsley A. Warfarin and epistaxis: should warfarin always be discontinued? Clin Otolaryngol Allied Sci. 1997;22(6):542-4.
13. Buchberger AMS, Baumann A, Johnson F, Peters N, Piontek G, Storck K, Pickhard A. The role of oral anticoagulants in epistaxis. Eur Arch Otorhinolaryngol. 2018;275(8):2035-43.
14. Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2011;125(1):38-42.
15. García Callejo FJ, Bécares Martínez C, Calvo González J, Martínez Beneyto P, Marco Sanz M, Marco Algarra J. Epistaxis y dabigatrán, nuevo anticoagulante oral no antagonista de la vitamina K. Acta Otorrinolaringológica Esp. 2014;65(6):346-54.
16. Glikson E, Chavkin U, Madgar O, Sagiv D, Nakache G, Yakirevitch A, Wolf M, Alon E. Epistaxis in the setting of antithrombotic therapy: a comparison between factor Xa inhibitors, warfarin, and antiplatelet agents. Laryngoscope. 2019; 129(1):119–23.
17. L’Huillier V, Badet C, Tavernier L. Epistaxis complicating treatment by anti-vitamin K and new oral anticoagulants. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(4):231-5.
18. Sauter TC, Hegazy K, Hautz WE, Krummrey G, Ricklin ME, Nagler M, Borner U, Exadaktylos AK. Epistaxis in anticoagulated patients: fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon. Clin Otolaryngol. 2018;43(1):103-8.
19. Send T, Bertlich M, Horlbeck F, Schafigh D, Freytag S, Eichhorn KW, Gräff I, Bootz F, Jakob M. Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin. Int Forum Allergy Rhinol. 2019;9(1):120-124.
20. Mateo J. Nuevos anticoagulantes orales y su papel en la práctica clínica. Rev Esp Cardiol Supl. 2013;13(3):33-41.
Martín-Bailón, M., López-Mesa, P., & Dios-Loureiro, C. (2020). Management of epistaxis in patients with anti-thrombotic therapy. Revista ORL, 12(2), 11–18. https://doi.org/10.14201/orl.24097
Most read articles by the same author(s)
- Myriam González-Sánchez, Enrique Coscarón-Blanco, Víctor Martín-Sánchez, Raquel Yáñez-González, María Martín-Bailón, Carmen Sánchez-Blanco, Hortensia Sánchez-Gómez, Symptoms and signs of unilateral and bilateral vestibular hypofunction , Revista ORL: Vol. 11 No. 1 (2020)
- María Martín-Bailón, Juan Bartual-Magro, Raquel Yáñez-González, Carmen Sánchez-Blanco, Víctor Martín-Sánchez, Mar De Prado-San José, Soledad Suárez-Ortega, Kimura disease , Revista ORL: SORIA 2019
- María Martín-Bailón, Raquel Yáñez-González, Soledad Suárez-Ortega, María del Mar De Prado-San José, Polymorphous adenocarcinoma of the soft palate , Revista ORL: Segovia 2018
- ENRIQUE Coscarón-Blanco, EVA PURIFICACIÓN Martín-Garrido, MARÍA Martín-Bailón, RAQUEL Yáñez-González, REFRACTORY CEPHALEA AND RHINITIS FOLLOWING DENTAL IMPLANT , Revista ORL: Segovia 2018
- Raquel Yáñez-González, Myriam González-Sánchez, María Martín-Bailón, Carmen Sánchez-Blanco, Victor Martín-Sánchez, Enrique Coscarón-Blanco, Hoagland's Sign in Infectious Mononucleosis , Revista ORL: Vol. 13 No. S2 (2022): XXVIII Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja Valladolid 2, 3 y 4 de junio de 2022
- María Martín-Bailón, Raquel Yáñez-González, Víctor Martín-Sánchez, Carmen Sánchez-Blanco, Enrique Coscarón-Blanco, Cruz Pérez-Liedo, Myriam González-Sánchez, Usher syndrome type II , Revista ORL: SORIA 2019
- María Martín-Bailón, Raquel Yáñez-González, Enrique Coscarón-Blanco, Myriam González-Sánchez, María Cruz Pérez-Liedo, Oropharyngeal and cervical lymphadenitis tularemia , Revista ORL: Segovia 2018
- María Martín-Bailón, Raquel Yáñez-González, Hortensia Sánchez-Gómez, Carmen Sánchez-Blanco, Myriam González-Sánchez, Víctor Martín-Sánchez, Enrique Coscarón-Blanco, Vestibular compensation , Revista ORL: Vol. 11 No. 1 (2020)
- ENRIQUE Coscarón-Blanco, EVA PURIFICACIÓN Martín-Garrido, RAQUEL Yáñez-González, MARÍA Martín-Bailón, MASSON TUMOR OF ORAL CAVITY: CLINICAL PRESENTATIONS , Revista ORL: Segovia 2018
- Enrique Coscarón-Blanco, Pablo Santos-Gorjón, María-Cruz Pérez-Liedo, Mar De Prado-San José, María Martín-Bailón, Michael Bauer, María-Soledad Suárez-Ortega, Miriam González-Sánchez, Causes of Peripheral Vertigo in Childhood , Revista ORL: Vol. 15 No. 2 (2024)
Downloads
Download data is not yet available.
+
−