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Haematological factors in the management of adult epistaxis: systematic review

  • A Williams (a1), A Biffen (a1), N Pilkington (a1), L Arrick (a1), R J Williams (a2), M E Smith (a3), M Smith (a4) and J Birchall (a5)...
Abstract
Background:

The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion.

Method:

A systematic review of the literature was performed using a standardised methodology and search strategy.

Results:

Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias.

Conclusion:

The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.

Copyright
Corresponding author
Address for correspondence: Dr Ashleigh Williams, Department of Anaesthesia, Derriford Hospital, Plymouth PL6 8DH, UK E-mail: ashleighwilliams@nhs.net
References
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1 Rainsbury, JW, Molony, NC. Clopidogrel versus low-dose aspirin as risk factors for epistaxis. Clin Otolaryngol 2009;34:232–5
2 Goddard, JC, Reiter, ER. Inpatient management of epistaxis: outcomes and cost. Otolaryngol Head Neck Surg 2005;132:707–12
3 Murer, K, Ahmad, N, Roth, BA, Holzmann, D, Soyka, MB. THREAT helps to identify epistaxis patients requiring blood transfusions. J Otolaryngol Head Neck Surg 2013;42:4
4 Pollice, PA, Yoder, MG. Epistaxis: a retrospective review of hospitalized patients. Otolaryngol Head Neck Surg 1997;117:4953
5 Khan, M, Conroy, K, Ubayasiri, K, Constable, J, Smith, ME, Williams, RJ et al. Initial assessment in the management of adult epistaxis: systematic review. J Laryngol Otol. In press
6 Daniels, PR. Peri-procedural management of patients taking oral anticoagulants. BMJ 2015;351:h2391
7 Keeling, D, Baglin, T, Tait, C, Watson, H, Perry, D, Baglin, C et al. ; British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin – fourth edition. Br J Haematol 2011;154:311–24
8 Denholm, SW, Maynard, CA, Watson, HG. Warfarin and epistaxis–a case controlled study. J Laryngol Otol 1993;107:195–6
9 Smith, J, Siddiq, S, Dyer, C, Rainsbury, J, Kim, D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol 2011;125:3842
10 Srinivasan, V, Patel, H, John, DG, Worsley, A. Warfarin and epistaxis: should warfarin always be discontinued? Clin Otolaryngol 1997;22:542–4
11 Bola, S, Marsh, R, Braggins, S, Potter, C, Hickey, S. Does the continuation of warfarin change management outcomes in epistaxis patients? J Laryngol Otol 2016;130:256–60
12 NICE Clinical Knowledge Summary. Anticoagulation: oral. In: https://cks.nice.org.uk/anticoagulation-oral [30 May 2017]
13 Burnett, AE, Mahan, CE, Vazquez, SR, Oertel, LB, Garcia, DA, Ansell, JA. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis 2016;41:206–32
14 European Medicines Agency. Pradaxa® – Summary of Product Characteristics. 2015. In: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf [30 May 2017]
15 Keeling, D, Tait, RC, Watson, H. Peri-operative management of anticoagulation and antiplatelet therapy. Br J Haematol 2016;175:602–13
16 Makris, M, Van Veen, JJ, Tait, CR, Mumford, AD, Laffan, M; British Committee for Standards in Haematology. Guideline on the management of bleeding in patients on antithrombotic agents. Br J Haematol 2013;160:3546
17 Callejo, FJ, Martínez, CB, González, JC, Beneyto, PM, Sanz, MM, Algarra, JM. Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant. Acta Otorrinolaringol Esp 2014;65:346–54
18 Pahs, L, Beavers, C, Schuler, P. The real-world treatment of hemorrhages associated with dabigatran and rivaroxaban: a multicenter evaluation. Crit Pathw Cardiol 2015;14:5361
19 Tay, HL, McMahon, AD, Evans, JM, MacDonald, TM. Aspirin, nonsteroidal anti-inflammatory drugs, and epistaxis. A regional record linkage case control study. Ann Otol Rhinol Laryngol 1998;107:671–4
20 Soyka, MB, Rufibach, K, Huber, A, Holzmann, D. Is severe epistaxis associated with acetylsalicylic acid intake? Laryngoscope 2010;120:200–7
21 Biggs, TC, Baruah, P, Mainwaring, J, Harries, PG, Salib, RJ. Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients. J Laryngol Otol 2013;127:483–8
22 Estcourt, LJ, Birchall, J, Allard, S, Bassey, SJ, Hersey, P, Kerr, JP et al. ; British Committee for Standards in Haematology. Guidelines for the use of platelet transfusions. Br J Haematol 2017;176:365–94
23 Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. National Blood Transfusion Committee Responses and Recommendations. In: http://www.transfusionguidelines.org/uk-transfusion-committees/national-blood-transfusion-committee/responses-and-recommendations [30 May 2017]
24 Napolitano, LM, Cohen, MJ, Cotton, BA, Schreiber, MA, Moore, EE. Tranexamic acid in trauma: how should we use it? J Trauma Acute Care Surg 2013;74:1575–86
25 Roberts, I, Shakur, H, Coats, T, Hunt, B, Balogun, E, Barnetson, L et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013;17:179
26 WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017;389:2105–16
27 NICE Guideline 24. Blood Transfusion. 2015. In: https://www.nice.org.uk/guidance/ng24 [30 May 2017]
28 Tibbelin, A, Aust, R, Bende, M, Holgersson, M, Petruson, B, Rundcrantz, H et al. Effect of local tranexamic acid gel in the treatment of epistaxis. ORL J Otorhinolaryngol Relat Spec 1995;57:207–9
29 Zahed, R, Moharamzadeh, P, Alizadeharasi, S, Ghasemi, A, Saeedi, M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013;31:1389–92
30 Petruson, B. Epistaxis. A clinical study with special reference to fibrinolysis. Acta Otolaryngol Suppl 1974;77:173
31 White, A, O'Reilly, BF. Oral tranexamic acid in the management of epistaxis. Clin Otolaryngol 1988;13:1116
32 Hunt, BJ, Allard, S, Keeling, D, Norfolk, D, Stanworth, SJ, Pendry, K; British Committee for Standards in Haematology. A practical guideline for the haematological management of major haemorrhage. Br J Haematol 2015;170:788803
33 NHS Blood and Transplant. Education. In: http://hospital.blood.co.uk/patient-services/patient-blood-management/education/ [2 August 2017]
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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