1 Objective
Epistaxis is the most common emergency in otolaryngology1,2, accounting for up to one third of all emergencies3,4. The treatment is discomforting and has a huge socio-economic impact5,6. Up to one third of all epistaxis patients in inpatient treatment are taking oral anticoagulants (OAC)7-9. A steep rising trend in this subgroup of epistaxis patients has been noted over the past several years10. As the general population of the industrialized countries becomes older, this tendency is expected to continue.
Until 2010, OACs were almost exclusively vitamin K inhibitors (VKA). However in the years following, a new generation of OACs, direct oral anticoagulants (DOAC), was introduced to the market. These drugs are Factor Xa or IIa inhibitors and are more easily administered as they do not require pharmacokinetics monitoring with dose adjustment11. The current cardiology and haematology guidelines favour DOACs over VKAs in the prevention of thromboembolic events in patients with atrial fibrillation11 and venous thromboembolism12. This has created a shift towards more DOAC patients in everyday practice, a shift which has also been confirmed and reported on in the most recent papers on epistaxis patients on OACs in the ENT emergency room7,13.
The purpose of the present study is to compare the outcomes of epistaxis patients taking DOACs and VKAs using a qualitative and quantitative synthesis of the available literature.