Williams A, Biffen A, Pilkington N, Arrick L, Williams R J, Smith M E, Smith M, Birchall J
Department of Anaesthesia,Derriford Hospital,Plymouth,UK.
Institute of Naval Medicine,Gosport,UK.
J Laryngol Otol. 2017 Dec;131(12):1093-1107. doi: 10.1017/S0022215117002067.
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.
A systematic review of the literature was performed using a standardised methodology and search strategy.
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.
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.
鼻出血的处理需要了解可能使其治疗复杂化的血液学因素。本系统评价包括六项不同的评价，旨在审查支持与华法林、直接口服抗凝剂、肝素、抗血小板药物、氨甲环酸和输血相关的鼻出血特异性处理策略的证据。
采用标准化方法和检索策略对文献进行系统评价。
每项系统评价中识别出的文章数量有限，仅有关于氨甲环酸使用的1级证据。在肝素、直接口服抗凝剂或输血系统评价中，没有研究符合纳入标准。许多研究受到样本量小和显著偏倚风险的限制。
多个来源的国家指南中对大出血的处理和输血实践有充分记录。这些指南包括关于抗凝剂、抗血小板药物和氨甲环酸的建议。在缺乏更具体证据的情况下，这些指南应用于鼻出血的处理。
