The impact of different anticoagulants and antiplatelets regimens on acute epistaxis outcomes.

Autor: Zloczower E; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel. chanani9@gmail.com., Pinhas S; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel., Allon R; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel., Syn-Hershko A; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel., Raz Yarkoni T; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel., Marom M; Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel., Kiderman D; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel., Cohen O; Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheba, Israel.; Division of Otorhinolaryngology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheba, Israel., Warman M; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2024 Sep; Vol. 281 (9), pp. 4863-4871. Date of Electronic Publication: 2024 May 23.
DOI: 10.1007/s00405-024-08718-6
Abstrakt: Background: The impact of anticoagulants (AC) and antiplatelets (AP) on the management of acute epistaxis remains unclear. This study investigated the association between AC/AP therapy and treatment outcomes in patients with acute epistaxis.
Methodology: A retrospective analysis of patients presented to the otolaryngology emergency room with acute epistaxis (2014-2022). Patients were categorized based on their regular medications: AP, dual AP therapy (DAPT), new oral anticoagulants (NOAC), vitamin K antagonists (VKA), or no regular AC/AP use (control group). Outcome measures included rates of minor interventions (chemical or electrical cautery, nasal tamponade), major interventions (endoscopic ligation, embolization), recurrent emergency department visits, admission rates, and duration.
Results: 786 patients were included with an average follow-up period of 52.56 ± 20.4 months. Compared to the control group, patients on AP, DAPT, or VKA had significantly higher rates of minor interventions (63.1% vs. 74.4%, 79.6%, and 77.3%, respectively, p < 0.05). DAPT users exhibited a higher rate of major interventions than the control (5.6% vs. 1.3%, p = 0.053). NOAC users showed no significant difference in minor interventions compared to control and required no major interventions. Both NOAC and VKA users had significantly higher rates of recurrent epistaxis events and prolonged hospitalization compared to the control (p < 0.01 and p < 0.05, respectively).
Conclusions: NOAC demonstrated more favorable outcomes than VKA in patients with acute epistaxis, and DAPT use was associated with an increased need for major interventions. These findings suggest a more conservative approach in NOAC users than other AC/AP agents.
(© 2024. The Author(s).)
Databáze: MEDLINE
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