Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZN, Scotland, UK.
Eur Arch Otorhinolaryngol. 2010 Oct;267(10):1641-4. doi: 10.1007/s00405-010-1243-x. Epub 2010 Apr 9.
Objective of the study is to investigate the role of clotting screen in adult patients presenting with epistaxis. The study is a prospective case series done in a teaching hospital in the Northeast of Scotland. Prospective data was collected for 100 consecutive patients with epistaxis admitted to the Department of Otolaryngology over 1 year (2006-2007 August). The demographics, co-morbidities, long-term medications and blood test results were noted for these patients. A retrospective audit of all patients attending the Emergency Department (ED) with epistaxis during the same study period was also performed. The following were measured: frequency of clotting screen performed in patients with epistaxis; the treatment modifying effect of clotting screen results. Of the 100 admitted patients, 45 were male and 55 were female. The majority of them had more than two co-morbidities such as hypertension, ischaemic heart disease and atrial fibrillation. Forty-seven patients were on aspirin, 19 on warfarin and 12 patients on clopidogrel. A clotting screen was done for 80 patients but only 2 patients (2.5%) had an abnormal INR. A total of 356 patients presented to the ED with epistaxis. Of 356 patients, 138 (39%) had their clotting screen checked. Of 138 patients, 42 (30%) were on warfarin. Only 7 patients (7/138 = 5%) had an abnormal result. Our data suggests that routine clotting screen check does not alter the epistaxis management in patients with no risk factors or with stable warfarin dosage. Therefore, routine clotting screen in patients with epistaxis without relevant risk factors is not an evidence-based practice.
研究旨在探讨凝血筛查在成人鼻出血患者中的作用。本研究为苏格兰东北部一所教学医院进行的前瞻性病例系列研究。在 1 年（2006 年至 2007 年 8 月）期间，对耳鼻喉科收治的 100 例连续鼻出血患者前瞻性收集数据。记录这些患者的人口统计学、合并症、长期用药和血液检查结果。还对同期在同一研究期间到急诊科就诊的所有鼻出血患者进行了回顾性审核。测量结果包括：对鼻出血患者进行凝血筛查的频率；凝血筛查结果对治疗的影响。100 例住院患者中，男性 45 例，女性 55 例。其中大多数患者合并 2 种以上的合并症，如高血压、缺血性心脏病和心房颤动。47 例患者服用阿司匹林，19 例服用华法林，12 例患者服用氯吡格雷。对 80 例患者进行了凝血筛查，但仅 2 例（2.5%）的国际标准化比值异常。共有 356 例患者因鼻出血到急诊科就诊。在 356 例患者中，有 138 例（39%）进行了凝血筛查。在 138 例患者中，有 42 例（30%）服用华法林。仅 7 例（7/138=5%）结果异常。我们的数据表明，在无危险因素或华法林剂量稳定的患者中，常规凝血筛查不会改变鼻出血的管理。因此，对于无相关危险因素的鼻出血患者，常规凝血筛查不是一种基于证据的实践。
