The long-term fate of epistaxis patients with exposure to antithrombotic medication.

UNLABELLED: 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. LEVEL OF EVIDENCE: This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects.

Emergency consultation for epistaxis: A bad predictor for overall health?

OBJECTIVE: To compare the mortality rate of a large epistaxis cohort with the fatalities of the general Swiss population and to evaluate significant risk factors for impending early death. METHODS: 568 patients out of an epistaxis cohort from a former study were contacted by mail to answer a questionnaire. Deceased patients were identified from March, 2007 through April, 2014. Death rates were compared to the general Swiss population. Different potential risk factors were evaluated by multivariate analysis. RESULTS: Thirty-four percent of the included patients (61 of total n=181) died during the observation period. The mean number of deaths per year was 8.7. Binary logistic regression identified anterior localization (p=0.027), comorbid endogenous bleeding predisposition including hemorrhagic hereditary telangiectasia (p=0.017) and age (p<0.01) as independent and significant risk factors for early death in epistaxis patients. A significantly higher mortality was found within our epistaxis cohort compared to the Swiss general population. CONCLUSION: With the present data a trivial event such as epistaxis, especially when anteriorly located, needs to be seen in a new light. Emergency consultation because of nose bleeding might be an unexpected bad predictor for mortality. Although conclusions need to be considered with caution due to the retrospective character of the study, we regard epistaxis as an independent alarm-signal. After an acute nose bleed requiring emergency consultation, active collaboration with the patient's general practitioner and additional efforts to check for the patient's general health might be more useful than so far assumed.

A prospective pilot study comparing nasal blood sampling and venipuncture for the assessment of hemoglobin levels and INR.

OBJECTIVES/HYPOTHESIS: This study is a pilot study evaluating the feasibility of sampling nose blood during an emergency using a commercially available rapid test device. It also compares the accuracy of rapid nasal blood test results to the results of standard laboratory methods using venous blood sampling. METHODS: Nose blood was collected in patients suffering from active epistaxis. In an emergency setting, hemoglobin levels and the international normalized ratio (INR) were assessed using a rapid point-of-care test device. These results were compared to standard laboratory analyses from venous blood taken at the same time from the same patient. Twenty patients consented to and participated in these assessments. RESULTS: Linear regression comparing venous and nasal samples revealed strong correlations between the two methods for both hemoglobin and INR measurement. A Bland-Altman analysis showed the mean difference to be 2.3 g/L when comparing hemoglobin measurements made using the rapid point-of-care device to hemoglobin measurements made using conventional lab assessment. The corresponding mean difference for INR measurements was 0.14. CONCLUSION: The results of this pilot study support the use of point-of-care test devices using nasal blood sampling and provide preliminary data demonstrating that a rapid testing method can be reliable, practicable, and time-efficient. In our opinion, rapid hematologic screening for nasal and capillary blood should be available in emergency wards that treat epistaxis. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:577-581, 2017.