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Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients

Published online by Cambridge University Press:  02 April 2013

T C Biggs*
Affiliation:
Department of ENT, University Hospital Southampton NHS Foundation Trust, UK
P Baruah
Affiliation:
Otorhinolaryngology Department, University Hospitals Birmingham NHS Foundation Trust, UK
J Mainwaring
Affiliation:
Department of Haematology, University Hospital Southampton NHS Foundation Trust, UK
P G Harries
Affiliation:
Department of ENT, University Hospital Southampton NHS Foundation Trust, UK
R J Salib
Affiliation:
Department of ENT, University Hospital Southampton NHS Foundation Trust, UK
*
Address for correspondence: Mr Timothy Biggs, ENT Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK Fax: +44 (0)2380 794 868 E-mail: [email protected]

Abstract

Background and objectives:

There is currently little published guidance on the management of anticoagulant and antiplatelet medication in patients admitted with epistaxis. The routine practice of withholding such medication in an attempt to control the epistaxis is common in the UK. However, this practice is not evidence-based, is often unnecessary, and can be associated with significant morbidity. This study introduces a treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients, validated through a completed audit cycle.

Methods:

One hundred patients admitted with epistaxis to the University Hospital Southampton NHS Foundation Trust were studied via a two-audit cycle covering the implementation of a new treatment algorithm formulated jointly by the otolaryngology and haematology departments.

Results:

On admission, 58 per cent of patients were taking some form of anticoagulant or antiplatelet medication. The number of patients having such medication withheld decreased significantly between the two audits, for all drugs studied (i.e. aspirin, clopidogrel and warfarin). There was no significant increase in re-bleeding or re-admission rates between the audits.

Conclusion:

Implementation of this treatment algorithm would help standardise management for epistaxis patients taking anticoagulant or antiplatelet drugs, and should reduce morbidity associated with unnecessary routine discontinuation of such medication.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Shehab, N, Sperling, LS, Kegler, SR, Budnitz, DS. National estimates of emergency department visits for hemorrhage-related adverse events from clopidogrel plus aspirin and from warfarin. Arch Intern Med 2010;170:1926–33CrossRefGoogle ScholarPubMed
2Elahi, MM, Parnes, LS, Fox, AJ, Pelz, DM, Lee, DH. Therapeutic embolisation in the treatment of intractable epistaxis. Arch Otolaryngol Head Neck Surg 1995;121:65–9CrossRefGoogle ScholarPubMed
3Smith, 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;125:3842CrossRefGoogle ScholarPubMed
4Vedovati, MC, Becattini, C, Agnelli, G. Combined oral anticoagulants and antiplatelets: benefits and risks. Intern Emerg Med 2010;5:281–90CrossRefGoogle ScholarPubMed
5Hollowell, J, Ruigómez, A, Johansson, S, Wallander, MA, García-Rodríguez, LA. The incidence of bleeding complications associated with warfarin treatment in general practice in the United Kingdom. Brit J Gen Pract 2003;53:312–14Google ScholarPubMed
6NHS National Institute for Health and Clinical Excellence: Atrial fibrillation (CG36). In: http://guidance.nice.org.uk/CG36 [5 January 2010]Google Scholar
7Laupacis, A, Boysen, G, Connolly, S, Ezekowitz, M, Hart, R, James, K et al. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449–57Google Scholar
8Sardella, G, Mancone, M, Biondi-Zoccai, G, Conti, G, Canali, E, Stio, R et al. Beneficial impact of prolonged dual antiplatelet therapy after drug-eluting stent implantation. J Interv Cardiol 2012;25:596603CrossRefGoogle ScholarPubMed
9Matheson, J. The UK population: how does it compare? Popul Trend 2010;142:629Google Scholar
10Stafford, RS, Singer, DE. National patterns of warfarin use in atrial fibrillation. Arch Intern Med 1996;156:2537–41CrossRefGoogle ScholarPubMed
11Choudhury, N, Sharp, HR, Mir, N, Salama, NY. Epistaxis and oral anticoagulant therapy. Rhinology 2004;42:92–7Google ScholarPubMed
12Metzler, H, Huber, K, Kozek-Langenecker, S, Vicenzi, MN, Münch, A. Coronary stents, dual antiplatelet therapy and peri-operative problems. Anaesthesist 2007;56:401–10CrossRefGoogle ScholarPubMed