title: A systematic review of anti-thrombotic therapy in epistaxis.
abstract: There is limited guidance available to clinicians regarding the management of antithrombotic therapy during epistaxis, whilst there has been an increase in the use of anticoagulation and antiplatelet therapy. In addition, the introduction of direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, over the last decade has significantly increased the complexity of managing the anticoagulated epistaxis patient. We undertook a systemic literature review investigating potential management strategies for each class of anti-thrombotic therapy during epistaxis. A PubMED and Cochrane Library search was performed on 10/03/16 using, but not limited to, the search terms epistaxis, nosebleed, nose bleeding, nasal haemorrhage, nasal bleeding AND each of the following search terms: antithrombotic, anticoagulant, antiplatelet, aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban, apixaban and tranexamic acid. This yielded 3815 results, of which 29 were considered relevant. Other sources such as national and international guidelines related to the management of anti-thrombotics were also utilised. We present the findings related to the management of each class of anti-thrombotic therapy during epistaxis. Overall we found a lack of evidence regarding this topic and further high quality research is needed. This is an area growing in complexity and the support of colleagues in Haematology and Cardiology is increasingly important.
authors: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors: K M
authors: KM
authors: Musgrave
authors: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors: J
authors: J
authors: Powell
mesh_terms: D000925:Anticoagulants; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001241:Aspirin; D000077144:Clopidogrel; D000069604:Dabigatran; D019468:Disease Management; D004844:Epistaxis / Q000628:therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D018570:Risk Assessment; D000069552:Rivaroxaban; D013988:Ticlopidine / Q000031:analogs & derivatives; D014148:Tranexamic Acid / Q000627:therapeutic use*; D014859:Warfarin
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D014148:Tranexamic Acid; D000069552:Rivaroxaban; D000077144:Clopidogrel; D000069604:Dabigatran; D013988:Ticlopidine; D001241:Aspirin