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Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients

Published online by Cambridge University Press:  02 April 2013

T C Biggs ,
P Baruah ,
J Mainwaring ,
P G Harries  and
R J Salib
T C Biggs*
Affiliation:
Department of ENT, University Hospital Southampton NHS Foundation Trust, UK
P Baruah
Affiliation:
Otorhinolaryngology Department, University Hospitals Birmingham NHS Foundation Trust, UK
J Mainwaring
Affiliation:
Department of Haematology, University Hospital Southampton NHS Foundation Trust, UK
P G Harries
Affiliation:
Department of ENT, University Hospital Southampton NHS Foundation Trust, UK
R J Salib
Affiliation:
Department of ENT, University Hospital Southampton NHS Foundation Trust, UK
*
Address for correspondence: Mr Timothy Biggs, ENT Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK Fax: +44 (0)2380 794 868 E-mail: tim_biggs@ymail.com
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Abstract

Background and objectives:

There is currently little published guidance on the management of anticoagulant and antiplatelet medication in patients admitted with epistaxis. The routine practice of withholding such medication in an attempt to control the epistaxis is common in the UK. However, this practice is not evidence-based, is often unnecessary, and can be associated with significant morbidity. This study introduces a treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients, validated through a completed audit cycle.

Methods:

One hundred patients admitted with epistaxis to the University Hospital Southampton NHS Foundation Trust were studied via a two-audit cycle covering the implementation of a new treatment algorithm formulated jointly by the otolaryngology and haematology departments.

Results:

On admission, 58 per cent of patients were taking some form of anticoagulant or antiplatelet medication. The number of patients having such medication withheld decreased significantly between the two audits, for all drugs studied (i.e. aspirin, clopidogrel and warfarin). There was no significant increase in re-bleeding or re-admission rates between the audits.

Conclusion:

Implementation of this treatment algorithm would help standardise management for epistaxis patients taking anticoagulant or antiplatelet drugs, and should reduce morbidity associated with unnecessary routine discontinuation of such medication.

Keywords

AnticoagulantsAntiplatelet DrugsClinical AuditGuidelinesEpistaxis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 5 , May 2013 , pp. 483 - 488
Copyright
Copyright © JLO (1984) Limited 2013 

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