Abstract
Objective : Epistaxis is the most common otolaryngological
emergency and up to one third of patients in treated on an inpatient
basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC),
an OAC subgroup, have been on the market since 2010 and are being
increasingly prescribed due to the cardiologic and hematologic
guidelines that favour them over vitamin K antagonists (VKA), the older
of the OAC subgroups. The present study aims to investigate which
subgroup of epistaxis patients taking OACs has a more favourable
outcome.
Design/Setting : A systematic review and meta-analysis were
performed according to the PRISMA 2020 statement using the PubMed and
Cochrane Library databases. Continuous data was analysed and
standardized mean difference (SMD) was calculated according to Hedges’
g. Dichotomous data was analysed and the Mantel-Haenszel method was
applied to establish the odds ratio (OR). Heterogeneity was assessed
according to the I2 statistics.
Main Outcome/Results : A total of 8 reports covering 1390
patients were included in the final synthesis. The pooled analysis
demonstrated significantly shorter hospital stays in the DOAC group
(SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher
rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to
.68, P= .001). No statistically significant differences with regard to
recurrence rates, admission rates, the need for transfusion, or surgical
intervention (P= .57, .12, .57 and .38 respectively) were found.
Conclusion : According to this meta-analysis, epistaxis patients
taking DOACs have a more favourable outcome than patients taking VKAs.
Keywords: anticoagulants, epistaxis, meta-analysis, doac, vka