Escabasse V, Bequignon E, Vérillaud B, Robard L, Michel J, Malard O, Crampette L
Service d'ORL et chirurgie cervico-faciale, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
Service d'ORL et chirurgie cervico-faciale, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2017 May;134(3):195-199. doi: 10.1016/j.anorl.2016.10.001. Epub 2016 Nov 9.
The authors present the guidelines of the French Society of Otorhinolaryngology concerning the management of epistaxis during antithrombotic therapy.
A review of the literature was performed by a multidisciplinary work group. Guidelines were drafted, then re-edited by a reading group independent of the work group to produce the final text. The proposed recommendations were graded A, B, C or expert opinion, on decreasing levels of evidence.
Before any decision to modify antithrombotic treatment, it is recommended to screen for overdose and assess the risk of thrombosis. In stented patients, dual antiplatelet therapy must be maintained during the month following stenting and, if possible, for 3 months. In epistaxis with antivitamin K (AVK) overdose controlled by packing, corrective measures are based on the International Normalized Ratio (INR). In uncontrolled epistaxis, it is recommended to stop AVK, administer antidotes and regularly monitor INR. In case of intravascular embolization, it is not recommended to alter anticoagulant treatment.
作者介绍了法国耳鼻咽喉科学会关于抗血栓治疗期间鼻出血管理的指南。
一个多学科工作小组对文献进行了综述。起草了指南，然后由一个独立于工作小组的阅读小组进行重新编辑以产生最终文本。所提出的建议根据证据水平的降低分为A、B、C级或专家意见。
在决定修改抗血栓治疗之前，建议筛查用药过量情况并评估血栓形成风险。对于置入支架的患者，在置入支架后的一个月内必须维持双重抗血小板治疗，如有可能，维持3个月。在通过填塞控制的抗维生素K（AVK）过量导致的鼻出血中，纠正措施基于国际标准化比值（INR）。在无法控制的鼻出血中，建议停用AVK，给予解毒剂并定期监测INR。在进行血管内栓塞的情况下，不建议改变抗凝治疗。
