Delayed Epistaxis in External Dacryocystorhinostomy Rate and Risk Factors

Objective: To report the incidence and risk factors associated with delayed epistaxis (2-8 days after the procedure) after external dacryocystorhinostomy (DCR). Design: We identified and analyzed all cases of patients who underwent external DCR procedures at 2 institutions from January 1999 through December 2005. Cases of delayed epistaxis and their final surgical outcome were compared with those without it. Setting: All patients who underwent surgery and were examined at 2 public hospitals in Melbourne, Australia. Patients: A total of 374 patients who underwent 437 DCRs. Interventions: Medical treatment, hospitalization, and endonasal examination with cautery. Main Outcome Measures: Rate of delayed epistaxis and current and past use of antiplatelet medications. Results: Of the 374 patients (mean [SD] age, 62 [18] years; 280 [75%] were women) who underwent 437 external DCRs, 15 (3.4%) had an episode of delayed epistaxis. They were generally older and more likely to have a history of active dacryocystitis compared with those who did not develop delayed epistaxis. Preoperative use of aspirin, nonsteroidal anti-inflammatory drugs, or warfarin sodium was not associated with delayed epistaxis or poorer surgical outcome if these anticoagulants were discontinued preoperatively as instructed. None of the 15 patients with delayed epistaxis had continued ingesting anticoagulants before undergoing DCR. Patients who developed epistaxis (80%) had a significantly lower rate of satisfactory surgical outcome than those who did not (90%) (P=.02). Conclusion: The risk of delayed epistaxis should be similar for patients taking or not taking anticoagulant agents if their use is stopped within a defined period of time before DCR.