Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany.
Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Philipps-University, Marburg, Germany.
Eur Arch Otorhinolaryngol. 2023 Apr;280(4):1723-1730. doi: 10.1007/s00405-022-07666-3. Epub 2022 Oct 1.
Epistaxis is the most common otolaryngological emergency and one-third of epistaxis patients regularly take low-dose acetylsalicylic acid (ASA) for the prevention of cardiovascular disease (CVD). The shift in contemporary guidelines identifies little benefit of ASA intake in patients who have not previously had an infarction. Existing evidence confirms ASA intake as a factor for severe epistaxis, while the evidence concerning its impact on recurrence is ambiguous. There are no available studies which justify the administration of these drugs nor are there any studies correlating the effects of these drugs to the SCORE2 CVD risk stratifying scale.
A retrospective analysis of all admitted epistaxis patients in a tertiary academic hospital for the 10 year period 2011 to 2021.
Patient data were analysed using the hospital information software. A recurrence was defined as an epistaxis episode requiring hospital readmittance for at least one night. Patients taking anticoagulants were excluded (N = 421).
444 patients were included: 246 were taking ASA and 198 were not (NoASA). ASA patients had more frequent recurrence in general (p = 0.03), more recurrences per patient (p = 0.002), and more changes in bleeding localisation (p = 0.04). Recurrence in the ASA group was associated with lower haemoglobin values (HR 0.62, p < 0.0001), while surgery (HR 6.83, p < 0.0001) was associated with recurrence in the NoASA group. ASA patients had a statistically significant (r 0.33, p = 0.032) correlation between the total number of epistaxis recurrences and SCORE2. The indication for drug intake was highly questionable in as much as 40% of ASA patients. Follow-up time was 5.27 years.
Epistaxis patients taking prophylactic ASA are significantly more burdened by recurrence, because they have more frequent recurrences, a greater number of recurrences per patient, and more changes in bleeding localisations when compared to control patients. The drug indication is questionable in up to 40% of ASA patients, exposing them unnecessarily to recurrence.
鼻出血是耳鼻喉科最常见的急症，三分之一的鼻出血患者为预防心血管疾病（CVD）而定期服用小剂量乙酰水杨酸（ASA）。当代指南的转变表明，对于从未发生过梗死的患者，ASA 摄入几乎没有益处。现有证据证实 ASA 摄入是导致严重鼻出血的一个因素，而关于其对复发影响的证据尚存在争议。目前尚无研究证明这些药物的给药是合理的，也没有研究将这些药物的效果与 SCORE2 CVD 风险分层量表相关联。
对 2011 年至 2021 年期间在一家三级学术医院收治的所有鼻出血患者进行回顾性分析。
使用医院信息软件分析患者数据。复发定义为需要住院至少一晚才能治疗的鼻出血发作。排除服用抗凝剂的患者（N=421）。
共纳入 444 例患者：246 例服用 ASA，198 例未服用（非 ASA）。ASA 患者总体上更频繁地复发（p=0.03），每位患者的复发次数更多（p=0.002），且出血部位变化更多（p=0.04）。ASA 组的复发与较低的血红蛋白值相关（HR 0.62，p<0.0001），而非 ASA 组的复发与手术相关（HR 6.83，p<0.0001）。ASA 患者的总鼻出血复发次数与 SCORE2 之间存在统计学显著相关性（r=0.33，p=0.032）。ASA 患者的药物摄入指征高度值得怀疑，占 40%。随访时间为 5.27 年。
服用预防性 ASA 的鼻出血患者因复发而显著加重负担，因为与对照组患者相比，他们的复发更频繁，每位患者的复发次数更多，且出血部位变化更多。ASA 患者中有多达 40%的药物指征值得怀疑，使他们不必要地面临复发风险。
