title: Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant.
abstract: OBJECTIVE
  Dabigatran is a new non-vitamin K antagonist (VKA) anticoagulant with anti-thrombin action, with supposedly fewer haemorrhagic complications. However, there are actually no established agents to reverse its effect, nor specific coagulation time tests for monitoring it.
  
  
  METHODS
  An observational prospective study was developed, noting epidemiological, clinical and therapeutic features among subjects with epistaxis treated with dabigatran. Results were compared with a group of epistaxis cases of individuals under anticoagulant therapy with VKA (acenocoumarol) and a control group without anticoagulation.
  
  
  RESULTS
  Since its inclusion in our health system almost 3 years ago, 19 patients with epistaxis and concomitant use of dabigatran have been attended at the Emergency Unit in our hospital, as against 59 under VKA therapy and 144 without anticoagulation, with a mean admittance rate of 26%, 28% and 14%, respectively. In 3 out of 5 individuals admitted due to dabigatran treatment, previously unobserved renal failure was detected. Blood transfusion was needed in 80% of patients using dabigatran, 58% using VKA and 23% without anticoagulation. Invasive procedures to control nosebleed were required in 80%, 35% and 21%, respectively. Although haemorrhagic risk was lower in dabigatran cases, they showed the longest stay in the hospital when compared to the other groups.
  
  
  CONCLUSIONS
  With dabigatran, there are fewer cases of severe epistaxis than with acenocoumarol, but controlling them is more difficult.
authors: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España. Electronic address: jgarciacall@hotmail.com.
authors: Francisco Javier
authors: FJ
authors: García Callejo
authors: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors: Carmen
authors: C
authors: Bécares Martínez
authors: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors: Jordi
authors: J
authors: Calvo González
authors: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors: Paz
authors: P
authors: Martínez Beneyto
authors: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors: Marta
authors: M
authors: Marco Sanz
authors: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors: Jaime
authors: J
authors: Marco Algarra
mesh_terms: D000074:Acenocoumarol / Q000009:adverse effects; D000368:Aged; D000991:Antithrombins / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000069604:Dabigatran / Q000009:adverse effects*; D004844:Epistaxis / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000991:Antithrombins; D014812:Vitamin K; D000069604:Dabigatran; D000074:Acenocoumarol
keywords: Adverse effects; Dabigatran; Dabigatrán; Efectos adversos; Epistaxis