Management of epistaxis in patients with anti-thrombotic therapy

Introduction and objective: epistaxis is one of the most frequent otorhinolaryngological emergencies. One of its causes is alterations in hemostasis caused by anti-thrombotic therapy. The aim of the study is to determine if there are differences in the management of epistaxis between patients with anti-thrombotic therapy and control patients. Method: retrospective analytical observational study of patients admitted to the Otorhinolaryngology service of a tertiary hospital, between January 2010 and December 2016. Epidemiological, clinical and therapeutic characteristics of the patients have been collected through their electronic medical records and comparative statistical analysis was performed between patients with anti-thrombotic therapy and control patients. Results: a total of 85 patients (74.1% male) were analyzed. Mean age at diagnosis of 66.7 years. 49.4% were undergoing anti-thrombotic therapy. Anterior nasal packing was performed in all patients and posterior nasal packing in 16 patients. 37 patients required endoscopic nasal surgery. Embolization was performed in four patients. In the comparative statistical study, no statistically significant differences were found between both groups in any of the variables analyzed. Discussion and conclusions: the current indications for anti-thrombotic therapy are very broad and therefore it is common to treat epistaxis in this type of patient. Although it has not been clearly demonstrated that anti-thrombotic therapy alone is associated with more serious bleeding, we believe that multidisciplinary management of these patients is essential in order to achieve adequate control of bleeding without the need for more aggressive interventions.