title: Postoperative haemorrhage in powered endoscopic dacryocystorhinostomy.
abstract: BACKGROUND
  The rate of postoperative haemorrhage has been reported inconsistently in retrospective studies of endoscopic dacryocystorhinostomy but has not been evaluated prospectively with the powered endoscopic technique. The purpose of this study was to assess the rate of postoperative haemorrhage in patients undergoing powered endoscopic dacryocystorhinostomy.
  
  
  METHODS
  A prospective, single-surgeon, observational case series.
  
  
  METHODS
  Cases 18 years old or more were included if they presented with radiologically confirmed primary acquired nasolacrimal duct obstruction. Exclusion criteria included evidence of canalicular disease, ectropion or facial palsy, and previous surgery on the lacrimal drainage system. One hundred seventy-four cases fulfilled the criteria for inclusion. The mean age of patients was 62.9 years, 65% were female.
  
  
  METHODS
  Powered endoscopic dacryocystorhinostomy.
  
  
  METHODS
  Postoperative haemorrhage. Significant haemorrhage was defined as that which necessitated packing, cautery, surgical intervention, a blood transfusion or delayed discharge.
  
  
  RESULTS
  The rates of total and significant postoperative haemorrhage were 1.7% and 0.6%, respectively. Antithrombotic agents were ceased on a case-by-case basis according to physician recommendation. Aspirin was stopped in 4 of 16 patients taking this agent preoperatively, and warfarin was stopped in one of three patients.
  
  
  CONCLUSIONS
  Significant postoperative haemorrhage following endoscopic dacryocystorhinostomy is rare. Further studies are required to assess whether antithrombotic agents significantly increase the risk of bleeding. The decision to cease agents should be made on a case-by-case basis in consultation with a physician.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Andrew
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000009:adverse effects*; D004724:Endoscopy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007766:Lacrimal Apparatus Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: dacryocystorhinostomy; epistaxis; haemorrhage