2 Design/Setting/Main Outcome
2.1 Literature search
The systematic review was done in accordance with the PRISMA
202014 statement. Two authors (PS and TW) searched
independently on PubMed and the Cochrane database on April
25th 2021 using the following criteria: (epistaxis AND
anticoagulation) OR (epistaxis AND DOAC). The search was restricted to
the years following the FDA approval15 of the first
DOAC (2009-2021). Disagreements were settled through consensus after
thorough analysis. Additionally, the references of reviewed papers were
also subject to analysis. No automatization tools were used in the
process.
2.2 Study selection, bias assessment and data retrieval
The inclusion criterion was two-armed studies (DOAC vs. VKA) on
consecutive epistaxis patients with a minimum of 20 patients in each
group. The exclusion criteria were absence of a thorough comparison
between DOAC and VKA groups, group size of <20 patients,
duplicate studies, case reports, reviews, comments, animal studies, and
letters to the editor. Data extraction was performed by two authors (PS
and TW) independently. All studies were assessed for bias using the
MINORS16 score for comparative non-randomized studies.
Discrepancies were settled after a consensus between all authors had
been reached.
2.3 Outcomes
The following outcomes were extracted: total number of epistaxis
patients taking DOACs and VKAs, admission rates, days in hospital,
posterior epistaxis, interventions needed, transfusions, recurrence
rates, and haemoglobin values.
2.4 Statistical analysis
The meta-analysis was performed using the MedCalc Statistical Software
version 17.8.6 (MedCalc Software bvba, Ostend, Belgium;
http://www.medcalc.org; 2017). A standardized mean difference (SMD) with
a 95% confidence interval (CI) and a pooled standard deviation (SE)
calculated according to Hedges’ g was used to compare the days in
hospital and haemoglobin values. Odds ratios (OR) with 95% CI according
to the Mantel-Haenszel method were used to compare the rates of
admission, posterior epistaxis, interventions, transfusions, and
recurrence. Heterogeneity was accessed according to I2statistics. When the I2 statistics did not reach
statistical significance, the fixed effects model was used; otherwise
the random effects model was applied. Forest and funnel plots were
created for each investigated result. A two sided P value <.05
was considered statistically significant.