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. 2018 Aug;275(8):2035-2043.
doi: 10.1007/s00405-018-5043-z. Epub 2018 Jun 23.

The role of oral anticoagulants in epistaxis

A M S Buchberger  1 , A Baumann  2 , F Johnson  1 , N Peters  1 , G Piontek  1 , K Storck  1 , A Pickhard  1
Affiliations

The role of oral anticoagulants in epistaxis

A M S Buchberger et al. Eur Arch Otorhinolaryngol. 2018 Aug.

Abstract

Purpose: The purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants.

Methods: The study was conducted at the Department for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication.

Results: 600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis.

Conclusion: Oral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.

Keywords: Epistaxis; New oral anticoagulants; Oral anticoagulants.

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Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest. Also, they declare that the manuscript has not been submitted to more than one journal for simultaneous consideration. The manuscript has not been published previously (partly or in full), unless the new work concerns an expansion of previous work. The single study is not split up into several parts. No data have been fabricated or manipulated to support our conclusions. No data, text, or theories by others are presented as if they were the author’s own. The manuscript has been read and improved by all authors. The requirements for authorship have been met.

Research involving human/animal participants

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was retrospective and was done in an anonymized way according to the data privacy protection law and in agreement to our ethic committee (90/16 S).

Figures

Fig. 1
Fig. 1
Age distribution of the epistaxis cohort (n = 541). Median age 64.2. Gender distribution: male 57.3%; female 42.7%. Median age < 18 years: 12.3
Fig. 2
Fig. 2
Underlying disease and risk factors for epistaxis of the in-patient cohort (n = 90). 77.8% of all admitted patients presented with ≥ 1 preexisting diseases
See this image and copyright information in PMC

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