Guidelines of the French Society of Otorhinolaryngology (SFORL). Managing epistaxis under coagulation disorder due to antithrombotic therapy.
OBJECTIVE
The authors present the guidelines of the French Society of Otorhinolaryngology concerning the management of epistaxis during antithrombotic therapy.


METHODS
A review of the literature was performed by a multidisciplinary work group. Guidelines were drafted, then re-edited by a reading group independent of the work group to produce the final text. The proposed recommendations were graded A, B, C or expert opinion, on decreasing levels of evidence.


RESULTS
Before any decision to modify antithrombotic treatment, it is recommended to screen for overdose and assess the risk of thrombosis. In stented patients, dual antiplatelet therapy must be maintained during the month following stenting and, if possible, for 3 months. In epistaxis with antivitamin K (AVK) overdose controlled by packing, corrective measures are based on the International Normalized Ratio (INR). In uncontrolled epistaxis, it is recommended to stop AVK, administer antidotes and regularly monitor INR. In case of intravascular embolization, it is not recommended to alter anticoagulant treatment.
Service d'ORL et chirurgie cervico-faciale, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France. Electronic address: virginie.escabasse@chicreteil.fr.
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V
Escabasse
Service d'ORL et chirurgie cervico-faciale, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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E
Bequignon
Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
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B
Vérillaud
Service d'ORL et chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France.
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Robard
Service d'ORL et chirurgie cervico-faciale, CHU La Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France.
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Michel
Service d'ORL et chirurgie cervico-faciale, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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O
Malard
Service d'ORL et chirurgie cervico-faciale, CHU Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
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Crampette
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000188:drug therapy; D004844:Epistaxis / Q000139:chemically induced* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005602:France; D006801:Humans; D010036:Otolaryngology; D012955:Societies, Medical; D013927:Thrombosis / Q000517:prevention & control
D000925:Anticoagulants
Anticoagulants; Antiplatelet agents; Direct oral anticoagulants; Epistaxis; New oral anticoagulants