title: Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study.
abstract: OBJECTIVE
  Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet therapy. This prospective study assessed the prevalence of epistaxis in patients taking anticoagulant and antiplatelet medication, and monitored differences in patients' clinical courses.
  
  
  METHODS
  Prospective data were collected for consecutive patients referred with epistaxis from the emergency department over a seven-month period. Emergency department records were used to investigate prevalence and referral rates.
  
  
  RESULTS
  Over the study period, 290 patients presented to the emergency department with epistaxis; this represented 0.9 per cent of all emergency attendances. Of these patients, 119 (39 per cent) were referred on to the ENT department, 62 per cent of whom were currently taking anticoagulant or antiplatelet medication. Patients taking anticoagulant and antiplatelet medication were a significantly older group (relative risk 1.50 (1.08-2.28), p = 0.01) requiring longer in-patient stays (relative risk 2.50 (1.01-4.97), p = 0.01) and more aggressive local haemostasis measures. Most patients taking warfarin had an international normalised ratio outside the appropriate range for their disease. Hypertension was not a factor in these patients' clinical course.
  
  
  CONCLUSIONS
  Increasingly, emergency and ENT departments are being presented with epistaxis in patients taking anticoagulant or antiplatelet medication. A better understanding of such medication and its effects may enable more effective management of these patients.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Birmingham, UK. joelsmith999@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Siddiq
authors.forename: C
authors.initials: C
authors.lastname: Dyer
authors.forename: J
authors.initials: J
authors.lastname: Rainsbury
authors.forename: D
authors.initials: D
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D004844:Epistaxis / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D019934:International Normalized Ratio; D007902:Length of Stay; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D014859:Warfarin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin