#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Change in anticoagulation therapy prescription in relation to severe epistaxis


Authors: Dagmar Zpěváková;  Vojtěch Beneda;  Martin Světlík
Authors‘ workplace: Oddělení otorinolaryngologie a chirurgie hlavy a krku, Krajská nemocnice T. Bati a. s., Zlín
Published in: Otorinolaryngol Foniatr, 73, 2024, No. 2, pp. 66-70.
Category: Original Article
doi: https://doi.org/10.48095/ccorl202466

Overview

Introduction: Epistaxis is vascular bleeding in the area of the nasal mucosa. Anticoagulation therapy increases the incidence of epistaxis. Anticoagulants are divided into direct and indirect depending on their effects. Direct anticoagulants are primarily novel oral anticoagulants (NOACs). Warfarin belongs to the group of indirect anticoagulants. Methodology: The retrospective study evaluates the benefit of the introduction of NOACs for otorhinolaryngology in connection with the occurrence of severe epistaxis. A comparison was done of the number of hospitalized adult patients with epistaxis over the course of 6 years during warfarin and NOAC treatment who were hospitalized with epistaxis at the ENT department of KNTB in Zlín between 2017–2022. The patient’s age and gender were also monitored. The severity of epistaxis was evaluated in relation to the used nasal packing and general anesthesia. The relationship with SÚKL data on the number of issued anticoagulant drugs is described. Results: During 6 years, a total of 221 patients were hospitalized for epistaxis, 32 were taking warfarin, and 20 were taking NOACs. The average age of patients with anticoagulant treatment was 78 years, represented by 61.5% men and 38.5% women. Over the years, we see a decrease in the number of epistaxis cases in warfarin patients; with NOACs the number is stationary. According to SÚKL statistics on preparations delivered to pharmacies in 2017 and 2022, there was a decrease in the prescription of warfarin by 44%; on the contrary, an increase of NOAC was up to 170%. Conclusion: With the decrease in the prescription of warfarin, we observe a reduced number of hospitalizations with severe epistaxis with this type of treatment. On the contrary, the increase in anticoagulation therapy with preparations from the NOAC group does not lead to an increase in the incidence of epistaxis, which also benefits the ENT field.

Keywords:

NOAC – warfarin – epistaxis – Anticoagulants


Sources

1. Pallin DJ, Chng YM, McKay MP et al. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005; 46 (1): 77–81. Doi: 10.1016/j.annemergmed.2004.12.014.

2. Elahi MM, Parnes LS, Fox AJ et al. Therapeutic embolization in the treatment of intactable epistaxis. Arch Otolaryngol Head Neck Surg 1995; 121 (1): 65–69. Doi: 10.1001/archotol.1995.01890010051 009.

3. Harry W, Daniell, MD. Estrogen preventiv of recurrent epistaxis. Arch Otolaryngol Head Neck Surg 1995; 121 (3): 354. Doi: 10.1001/arch otol.1995.01890030080017

4. Send T, Bertlich M, Horlbeck F et al. Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin. Int Forum Allergy Rhinol 2019; 9: 120–124. Doi: 10.1002/alr.22210.

5. Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician 2005; 71 (2): 305–311.

6. Krulewitz NA, Fix ML. Epistaxis. Emerg Med Clin North Am 2019; 37 (1): 29–39. Doi: 10.1016/j.emc.2018.09.005.

7. Viehweg TL, Roberson JB, Hudson JW. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg 2006; 64 (3): 511–518. Doi: 10.1016/ j.joms.2005.11.031.

8. DeWald TA, Washam JB, Becker RC. Anticoagulants: Pharmacokinetics, Mechanisms of Action, and Indications. Neurosurg Clin N Am 2018; 29 (4): 503–515. Doi: 10.1016/j.nec.2018.06.003.

9. Gregorová J, Tašková I et al (eds). Antikoagulační terapie. Praha: Maxdorf 2022: 15–25.

10. Kirchhof P, Benussi S, Kotecha D et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 (38): 2893–2962. Doi: 10.1093/ejcts/ezw313.

11. Kvasnička T. Nová antikoagulancia a jejich současné indikace. Med praxi 2012; 9 (5): 230–232.

12. Lincová D, Farghali H et al. Základní a aplikovaná farmakologie. 2. vyd. Praha:  Galén 2007: 272–277.

13. Witt DM, Clark NP, Kaatz S et al. Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism. J Thromb Trombolysis 2016; 41 (1): 187–205. Doi: 10.1007/s11239-015-1319-y.

14. Knížek Z, Vodička J. Nosní tamponády – přehled materiálů. Otorinolaryngol Foniatr 2016; 65 (1): 35–42.

15. Státní úřad pro kontrolu léčiv SÚKL. Dodávky léčiv – se zaměřením na léčivé látky. 2023 [online]. Dostupné z: https: //www.sukl.cz/dodavky-leciv-se-zamerenim-na-lecive-latky.

16. Yaniv D, Zavdy O, Sapir E et al. The Impact of Traditional Anticoagulants, Novel Anticoagulants, and Antiplatelets on Epistaxis. Laryngoscope 2021; 131 (9): 1946–1951. Doi: 10.1002/lary.29417.

17. Lip GYH, Keshishian A, Li X et al. Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients. The ARISTOPHANES Study. Stroke 2018; 49 (12): 2933– –2944. Doi: 10.1161/STROKEAHA.118.020232.

18. Ingason AB, Rumba E, Hreinsson JP et al. Warfarin is associated with higher rates of epistaxis compared to direct oral anticoagulants: A nationwide propensity score-weighted study. J Intern Med 2022; 292 (3): 501–511. Doi: 10.1111/joim.13498.

Přijato k recenzi: 28. 9. 2023
Přijato k tisku: 19. 12. 2023

MUDr. Dagmar Zpěváková
Oddělení otorinolaryngologie a chirurgie hlavy a krku
Krajská nemocnice T. Bati, a. s.
Havlíčkovo nábř. 600
762 75 Zlín
DasaManaskova@seznam.cz

Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#