title: The long-term fate of epistaxis patients with exposure to antithrombotic medication.
abstract: The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short- but also in a long-term perspective.
  
  
  METHODS
  This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich USZ, University of Zurich UZH, 8091, Zurich, Switzerland.
authors: Rafael R
authors: RR
authors: Stadler
authors: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich USZ, University of Zurich UZH, 8091, Zurich, Switzerland.
authors: Rahel
authors: R
authors: Kindler
authors: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich USZ, University of Zurich UZH, 8091, Zurich, Switzerland.
authors: David
authors: D
authors: Holzmann
authors: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich USZ, University of Zurich UZH, 8091, Zurich, Switzerland. michael.soyka@usz.ch.
authors: Michael B
authors: MB
authors: Soyka
mesh_terms: D000328:Adult; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D004844:Epistaxis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D012720:Severity of Illness Index; D013557:Switzerland; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D005343:Fibrinolytic Agents; D014812:Vitamin K; D001241:Aspirin
keywords: ASA; Acetylsalicylic acid; Aspirin; Epistaxis; Nose bleed; Prevalence; Prognosis; Recurrence; Risk factors; Warfarin