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Management of epistaxis in patients on novel oral anticoagulation therapy

Published online by Cambridge University Press:  13 April 2020

J P K Ho ,
N Bari  and
F Riffat
J P K Ho*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Australia Sydney Medical School, University of Sydney, Camperdown, Australia
N Bari
Affiliation:
Department of Emergency Medicine, Blacktown Hospital, Australia
F Riffat
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Australia Sydney Medical School, University of Sydney, Camperdown, Australia
*
Author for correspondence: Dr Joyce Ho, Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Hawkesbury Road, Westmead, New South Wales, Australia 2145 E-mail: joycepkho@gmail.com Fax: +61 2 8890 9852
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Abstract

Background

Individuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy.

Objective

This paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management.

Method

A comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019.

Results

Patients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined.

Conclusion

Clinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.

Keywords

AnticoagulantsDabigatranEpistaxisFirst AidRivaroxaban

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 4 , April 2020 , pp. 316 - 322
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Dr Joyce Ho takes responsibility for the integrity of the content of the paper

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