Maina Grace, Ooi Eng
Dept of Otolaryngology Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia.
Dept of Otolaryngology Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia; College of Medicine and Public Health, Flinders University, South Australia, Australia.
Am J Otolaryngol. 2022 Jul-Aug;43(4):103488. doi: 10.1016/j.amjoto.2022.103488. Epub 2022 May 4.
The incidence of epistaxis-related admissions amongst elderly patients is rising due to the increasing use of anticoagulants and antiplatelet agents. This retrospective study evaluates the differences in outcomes for patients on warfarin, novel anticoagulants (NOACs) and antiplatelets over two different time periods.
Retrospective case-control study with data from patients admitted with epistaxis through the Flinders Medical Centre Emergency Department in the first six months of 2013 and compared to the same period in 2018. The latter coincides with integration of NOACs into Australian prescribing practices. Included participants were ≥50 years with spontaneous epistaxis which coincides with peak incidence in adults. Exclusion criteria were epistaxis due to trauma, intrinsic coagulopathy, or recent post-surgery. Linear regression and binary logistic regression models were the statistical methods used.
Data from 85 patients were analysed for length of stay (LOS), readmission rates and method of haemostasis. In 2013, 41 patients were included compared to 44 in 2018, suggesting a 7% increase in admissions rates but this was not statistically significant (p = 0.96). The proportion of patients admitted with epistaxis while taking an anticoagulant or antiplatelet agent increased from 66% in 2013 to 93% in 2018. Thirty six percent of patients in 2018 were taking NOACs, however, LOS was 2 times shorter (mean ratio = 2.08 days, 95% CI: 1.03, 4.19). Seven percent of patients in 2018 had bleeding requiring surgery or interventional radiology, compared to 12% in 2013, but this was not statistically significant. There was no statistically significant difference in readmission rates (p = 0.82) or intervention required (p = 0.74) between the two time periods.
Epistaxis admissions at our institution have increased since the introduction of NOACs. However, most patients can be managed successfully with intranasal packing and cautery alone. NOACs are not associated with increased rated of invasive haemostatic measures and patients have a shorter LOS.
由于抗凝剂和抗血小板药物的使用增加，老年患者鼻出血相关住院率正在上升。这项回顾性研究评估了华法林、新型抗凝剂（NOACs）和抗血小板药物在两个不同时间段内患者的结局差异。
回顾性病例对照研究，收集2013年前六个月通过弗林德斯医疗中心急诊科因鼻出血入院患者的数据，并与2018年同期进行比较。后者恰逢NOACs纳入澳大利亚处方实践。纳入的参与者年龄≥50岁，有自发性鼻出血，这与成年人的发病率高峰一致。排除标准为因外伤、先天性凝血障碍或近期手术后引起的鼻出血。使用线性回归和二元逻辑回归模型作为统计方法。
分析了85例患者的住院时间（LOS）、再入院率和止血方法的数据。2013年纳入41例患者，2018年为44例，表明入院率增加了7%，但无统计学意义（p = 0.96）。服用抗凝剂或抗血小板药物时因鼻出血入院的患者比例从2013年的66%增加到2018年的93%。2018年36%的患者服用NOACs，然而，住院时间缩短了2倍（平均比值=2.08天，95%CI：1.03，4.19）。2018年7%的患者出血需要手术或介入放射治疗，而2013年为12%，但无统计学意义。两个时间段之间的再入院率（p = 0.82）或所需干预措施（p = 0.74）无统计学显著差异。
自引入NOACs以来，我们机构的鼻出血住院人数有所增加。然而，大多数患者仅通过鼻内填塞和烧灼即可成功治疗。NOACs与侵入性止血措施发生率增加无关，且患者住院时间较短。
