Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-27T23:06:27.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Does the continuation of warfarin change management outcomes in epistaxis patients?

Published online by Cambridge University Press:  28 December 2015

S Bola ,
R Marsh ,
S Braggins ,
C Potter  and
S Hickey
S Bola*
Affiliation:
Otolaryngology Department, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK
R Marsh
Affiliation:
Otolaryngology Department, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK
S Braggins
Affiliation:
Otolaryngology Department, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK
C Potter
Affiliation:
Otolaryngology Department, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK
S Hickey
Affiliation:
Otolaryngology Department, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK
*
Address for correspondence: Miss Sumrit Bola, ENT Department, John Radcliffe Hospital, Oxford OX3 9DU, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study aimed to compare management, readmission rates and length of in-patient stay amongst warfarinised and non-warfarinised patients to ascertain future treatment protocols.

Methods:

A 12-month retrospective review was conducted of ENT epistaxis admissions. Admission details such as length of in-patient stay, clotting profile and management plan were recorded. Comparisons of management and outcome for warfarinised and non-warfarinised patients were made using the Fisher's exact paired t-test.

Results:

Of 176 epistaxis patients admitted, 31 per cent were warfarinised, 18 per cent were on another form of anticoagulation or antiplatelet therapy, and 51 per cent were not on any medication that might impose a bleeding risk. The international normalised ratio at admission was high in 13 per cent of warfarinised patients; the remaining patients had therapeutic or sub-therapeutic international normalised ratios and so warfarin was continued. The mean in-patient stay was similar for all cohorts; however, warfarinised patients had a higher readmission rate.

Conclusion:

Warfarinised epistaxis patients may be safely managed without stopping their anticoagulation therapy, provided their international normalised ratio is at therapeutic or sub-therapeutic levels. By continuing regular anticoagulation therapy, warfarinised patients may be discharged without delay.

Keywords

EpistaxisPatient AdmissionCostPainPatient DischargeWarfarin
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 3 , March 2016 , pp. 256 - 260
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Shantsila, E, Wolff, A, Lip, G, Lane, D. Optimising stroke prevention in patients with atrial fibrillation: application of the GRASP-AF audit tool in a UK general practice cohort. Br J Gen Pract 2015;65:e16–23CrossRefGoogle Scholar
2Pirmohamed, M. Warfarin: almost 60 years old and still causing problems. Br J Clin Pharmacol 2006;62:509–11CrossRefGoogle ScholarPubMed
3NHS Hospital Episode Statistics in England and Wales 2009–2010. In: http://www.hesonline.nhs.uk [18 February 2013]Google Scholar
4Herkner, H, Laggner, AN, Mullner, M, Formanek, M, Bur, A, Gamper, G et al. Hypertension in patients presenting with epistaxis. Ann Emerg Med 2000;35:126–30CrossRefGoogle ScholarPubMed
5SIGN 129: Antithrombotics: indications and management. In: http://www.sign.ac.uk/guidelines/fulltext/129/index.html [26 November 2015]Google Scholar
6Biggs, AC, Baruah, P, Mainwaring, J, Harries, PG, Salib, RJ. Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients. J Laryngol Otol 2013;127:483–8CrossRefGoogle ScholarPubMed
7NICE CKS Guidelines. Anticoagulation - oral. In: http://cks.nice.org.uk/anticoagulation-oral#!scenario:3 [26 November 2015]Google Scholar
8Smith, J, Siddiq, S, Dyer, C, Rainsbury, J, Kim, D. Epistaxis inpatients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol 2011;125:38–42CrossRefGoogle ScholarPubMed
9Stroke Prevention in Atrial Fibrillation Investigators. Bleeding during antithrombotic therapy in patients with atrial fibrillation. Arch Intern Med 1996;156:409–16CrossRefGoogle Scholar
10Smithard, A, Wynne, D, Bingham, BJ, Jones, NS. Endonasal laser dacryocystorhinostomy: its role in anticoagulated patients. Laryngoscope 2003;113:1034–6CrossRefGoogle ScholarPubMed
11Rudmik, L, Leung, R. Cost-effectiveness analysis of endoscopic sphenopalatine artery ligation vs arterial embolization for intractable epistaxis. JAMA Otolaryngol Head Neck Surg 2014;140:802–8CrossRefGoogle ScholarPubMed
12Dedhia, RC, Desai, SS, Smith, KJ, Lee, S, Schaikin, BM, Synderman, CH et al. Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis. Int Forum Allergy Rhinol 2013;3:563–6CrossRefGoogle ScholarPubMed