Management of epistaxis associated with oral antithrombotic drugs in Emergency Department and impact on prescription thereafter

AlexandrosSfakianakis shared this article with you from Inoreader Management of epistaxis associated with oral antithrombotic drugs in Emergency Department and impact on prescription thereafter via Clinical Otolaryngology ABSTRACT OBJECTIVES To describe management, and to assess factors associated with antithrombotic prescription thereafter in patients who had epistaxis referred to emergency department. DESIGN Prospective cohort study. From emergency departments, clinical, biological and hospital data were collected. The clinical database was linked to the French Health Insurance Database where we retrieved antithrombotic drug deliveries in a 3-month period before and after referral. SETTING Multicentric population-based cohort study within five well-defined areas. PARTICIPANTS We considered 306 patients referred for epistaxis with a stable oral antithrombotic regimen before referral. MAIN OUTCOME MEASURES We considered management, hospital outcome and case fatality. Antithrombotic prescription in a 3-month follow-up period was categorized into 3 classes: no change, class change, or discontinuation. During follow-up, hospitalization for epistaxis or ischemic events were searched. RESULTS Among 306 adult individuals (mean age: 76 years), 166 took oral anticoagulant and 140 an antiplatelet drug. Blood transfusion was needed in 13.7% of patients and anterior packing alone in 61%. Half of the patients were hospitalized; 301 were discharged alive. Considering antithrombotic prescription thereafter we observed no change in 219 patients (72.8%), class changes in 47 patients (15.6%) and discontinuation in 35 patients (11.6%). We identified four independent predictors for antithrombotic prescription: hospitalization (vs. returning home, P = 0.05), age (P = 0.03), hemoglobin level (P = 0.03) and oral anticoagulant (vs. antiplatelet agent, P <.001). During the three months following discharge, 2 thrombotic and 15 bleeding events were identified. CONCLUSIONS Epistaxis referred to emergency department had an impact on subsequent antithrombotic prescription. This article is protected by copyright. All rights reserved. View on Web

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