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Haematological factors in the management of adult epistaxis: systematic review

Published online by Cambridge University Press:  27 December 2017

A Williams ,
A Biffen ,
N Pilkington ,
L Arrick ,
R J Williams ,
M E Smith ,
M Smith  and
J Birchall
A Williams*
Affiliation:
Department of Anaesthesia, Derriford Hospital, Plymouth, UK
A Biffen
Affiliation:
Department of Anaesthesia, Derriford Hospital, Plymouth, UK
N Pilkington
Affiliation:
Department of Anaesthesia, Derriford Hospital, Plymouth, UK
L Arrick
Affiliation:
Department of Anaesthesia, Derriford Hospital, Plymouth, UK
R J Williams
Affiliation:
Institute of Naval Medicine, Gosport, UK
M E Smith
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
M Smith
Affiliation:
Exeter Health Library, Peninsula Medical School, UK
J Birchall
Affiliation:
Department of Haematology, North Bristol NHS Trust, NHS Blood and Transplant, Bristol, UK
*
Address for correspondence: Dr Ashleigh Williams, Department of Anaesthesia, Derriford Hospital, Plymouth PL6 8DH, UK E-mail: ashleighwilliams@nhs.net
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Abstract

Background:

The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion.

Method:

A systematic review of the literature was performed using a standardised methodology and search strategy.

Results:

Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias.

Conclusion:

The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.

Keywords

EpistaxisTherapyCoumarinsHeparinBlood
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1093 - 1107
Copyright
Copyright © JLO (1984) Limited 2017 

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