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Safety Profile of Novel Oral Anticoagulants an Improvement Over Traditional Anticoagulants, Antiplatelets for Epistaxis

by Linda Kossoff •

What is the impact of novel oral anticoagulants (NOAC) on the risk of epistaxis and its severity?

BOTTOM LINE

Compared to older generation anticoagulants and antiplatelet drugs (ACAP), NOAC demonstrated an improved safety profile for epistaxis severity, need for hospital admission, and hospitalization duration.

BACKGROUND: Epistaxis makes up 0.5% to 1% of all emergency department (ED) visits. Reports have shown that antithrombotic therapy is used in up to 60% of patients admitted for epistaxis and is associated with longer hospital stays and higher readmission rates. Recent studies comparing epistaxis in patients taking NOACs and those receiving ACAP show conflicting results.

STUDY DESIGN: Retrospective review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.

SYNOPSIS: Researchers identified 470 adult patients (56% males, average age 63 years) at the ED of a single hospital from 2012 to 2018 with a diagnosis of epistaxis. Of these, 241 were taking old and new generation ACAP (ACAP group) and 229 were not taking ACAP (control group). Primary outcomes were severity of epistaxis, hospital admission, prolonged hospitalization (>3 days), and recurrence of epistaxis leading to further ED visits. In comparing the groups, age-adjusted rates showed the ACAP group was more likely to be hospitalized and at a higher risk for severe epistaxis. Patients receiving traditional anticoagulants and patients receiving antiplatelets had similar admission (25% vs 27%), recurrence (13% vs 15%), and prolonged hospitalization rates (both at 15%). Compared to patients taking traditional ACAP, those taking NOAC did not show an increased risk of severe epistaxis and/or recurrence and demonstrated similar epistaxis outcomes to the control group. Overall, NOAC demonstrated an improved safety profile compared to ACAP, suggesting a more conservative treatment approach is sufficient for patients taking NOAC. Study limitations included limited groups within the larger cohort.

CITATION: Yaniv D, Zavdy O, Sapir E, et al. The impact of traditional anticoagulants, novel anticoagulants, and antiplatelets on epistaxis. Laryngoscope. 2021;131:1946-1951.