Key result
DOACs linked to shorter hospital stays and ~61% less posterior bleeding vs VKAs in epistaxis.
Why the study?
Direct oral anticoagulants (DOACs) are increasingly prescribed over vitamin K antagonists (VKAs) in patients taking oral anticoagulants, but their comparative outcomes in epistaxis patients are unclear.
Meta-Analysis (n=1,390)
Answers are grounded in this paper and cite their sources.
DOAC-treated epistaxis patients have shorter stays and less posterior bleeding than VKA-treated; reinforces guideline preference for DOACs in bleeding-prone patients.
Objective: Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiologic and hematologic guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/Setting: A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data was analysed and standardized mean difference (SMD) was calculated according to Hedges’ g. Dichotomous data was analysed and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main Outcome/Results: A total of 8 reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to .68, P= .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion, or surgical intervention (P= .57, .12, .57 and .38 respectively) were found. Conclusion: According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.
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Stanković et al. (2021) conducted a meta-analysis in Epistaxis (n=1,390). Direct oral anticoagulants (DOAC) vs. Vitamin K antagonists (VKA) was evaluated on Hospital stay length (SMD -0.22, 95% CI -0.42 to -0.02, p=0.03). DOAC use in epistaxis patients was associated with shorter hospital stays (SMD -0.22; 95% CI -0.42 to -0.02) and less posterior bleeding (OR 0.39; 95% CI 0.23 to 0.68) compared to VKAs.
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