(0302) Assessing Epistaxis Control Strategies in Anticoagulated Patients: A Retrospective Cohort Study

Introduction: Anticoagulated patients are at an increased risk of epistaxis. We investigated whether they require more complicated methods of epistaxis control than non anticoagulated patients.

Methods: A retrospective cohort study was conducted using the US Network in TriNetX. ICD-10 R04.0 identified adults with epistaxis. Patients were grouped by anticoagulants (warfarin, Gllb/llla antagonists, antithrombin potentiators, factor Xa inhibitors, and thrombin inhibitors) and non-anticoagulated (control). Coagulopathies were excluded. Control of nasal bleeding within 7 days of epistaxis was recorded for each group: limited anterior cautery or packing (LAP), extensive anterior cautery or packing (EAP), initial posterior cautery or packing (PP), repeat posterior cautery or packing (RPP), nasal endoscopy with control of epistaxis (ECE), and ligation of ethmoidal or maxillary artery (LEMA). Each group was propensity score matched for age, gender, and race. Relative risk and chi square tests were calculated.

Results: Both control and anticoagulated groups contained 193,073 patients with mean age of 63.1 (SD = 20) years. Controls were more likely to require LAP (p < 0.001), with 20,747 (10.7%) undergoing LAP and 4,781 (2.5%) undergoing EAP compared to 13,275 (6.9%) and 3,321 (1.7%) anticoagulated patients. Controls were more likely to undergo PP (RR = 1.4, CI:1.3-1.5, N = 1,669, 0.9%, p < 0.001) or RPP (RR = 1.2, CI:1.0-1.4, N = 306, 0.2%, p = 0.022). Of the total, 1,212 (0.6%) anticoagulated patients required PP and 2,520 (0.1%) required RPP. No difference was found between control and anticoagulated groups undergoing ECE or LEMA. Anticoagulated patients were 1.3x (CI:1.2-1.3, N = 10,253, 5.3%, p < 0.001) more likely to undergo drug therapy with tranexamic acid, Vitamin K, or thrombin. Those on warfarin were 1.4x more likely (CI:1-2, N = 80/38,137, 0.2%, p = 0.039) than controls (N = 56/38,137, 0.1%) to undergo PP.

Conclusions: Anticoagulated patients generally do not have a higher risk of undergoing procedural control of epistaxis, likely because of medical therapy that can reverse anticoagulation.