Department of Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany.
Department of Otolaryngology, Head and Neck Surgery, Phillips-University Marburg, Marburg, Germany.
J Thromb Thrombolysis. 2019 Apr;47(3):384-391. doi: 10.1007/s11239-019-01824-x.
Patients taking oral anticoagulants (OACs) currently represent one-third of all patients treated for epistaxis and an upward trend is expected. New direct oral anticoagulants (DOACs) have been on the market for approximately 10 years. DOACs are favoured over Vitamin K-Antagonists (VKAs) in the current guidelines. There are barely studies that investigate the impact of DOACs on patients with epistaxis. A retrospective study was performed analysing all patients who had stationary treatment for epistaxis from 01.01.2011 to 01.01.2018 in a tertiary care centre. In a total of 466 patients, 46.1% were on OACs. The main indication was atrial fibrillation (AF, 67.4%).The number of DOACs taken surpassed that of the VKAs during the past 2 years. The length of hospital stay was significantly longer in the phenprocoumon group (3 ± 0.2 days) in comparison to both the rivaroxaban (2.3 ± 0.1) and the apixaban (2.2 ± 0.1) groups (p = 0.005). Posterior epistaxis occurred more frequently in the phenprocoumon group (10.8%) than in the rivaroxaban (0%) and apixaban (0%) groups (p = 0.03). A correlation between CHADS-VASc score (risk score for apoplexy in patients with AF, p = 0.01), HAS-BLED score (score for assessment of major bleeding in patients taking anticoagulants with AF, p = 0.006), and length of hospital stay (p = 0.002) with recurrence of epistaxis was found. Shorter hospital stays and exclusively anterior bleeding was noted in AF patients taking rivaroxaban and apixaban, whereas AF patients taking phenprocoumon stayed in hospital longer and had more posterior bleeding.
目前，接受口服抗凝剂 (OAC) 治疗的患者占所有接受鼻出血治疗患者的三分之一，预计这一趋势还将继续上升。新型直接口服抗凝剂 (DOAC) 上市已有约 10 年。目前的指南更倾向于 DOAC 而非维生素 K 拮抗剂 (VKA)。几乎没有研究调查 DOAC 对鼻出血患者的影响。本回顾性研究分析了 2011 年 1 月 1 日至 2018 年 1 月 1 日期间在一家三级保健中心接受固定鼻出血治疗的所有患者。在 466 名患者中，46.1%正在服用 OAC。主要适应症为心房颤动 (AF，67.4%)。在过去的 2 年中，服用 DOAC 的人数超过了 VKA。与华法林组（3 ± 0.2 天）相比，利伐沙班组（2.3 ± 0.1 天）和阿哌沙班组（2.2 ± 0.1 天）的住院时间明显更长（p=0.005）。与利伐沙班组（0%）和阿哌沙班组（0%）相比，华法林组（10.8%）后鼻出血的发生率更高（p=0.03）。CHADS-VASc 评分（AF 患者中风风险评分，p=0.01）、HAS-BLED 评分（AF 患者服用抗凝剂后大出血评估评分，p=0.006）和住院时间（p=0.002）与鼻出血复发之间存在相关性。服用利伐沙班和阿哌沙班的 AF 患者住院时间更短，且仅出现前鼻出血，而服用华法林的 AF 患者住院时间更长，且后鼻出血更多。
