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.