Risk factors and management outcomes in epistaxis: a tertiary centre experience

Jed M Hughes; Bing Mei Teh; Cameron J Hart; Harry H Gibbs; Ar Kar Aung

doi:10.1111/ans.18179

Risk factors and management outcomes in epistaxis: a tertiary centre experience

ANZ J Surg. 2023 Mar;93(3):555-560. doi: 10.1111/ans.18179. Epub 2022 Dec 20.

Authors

Jed M Hughes¹, Bing Mei Teh^{1

2}, Cameron J Hart¹, Harry H Gibbs^{3

4}, Ar Kar Aung^{4

5}

Affiliations

¹ Department of ENT, Head Neck Surgery, Austin Health, Melbourne, Victoria, Australia.
² Department of Otolaryngology, Head and Neck Surgery, Monash Health; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
³ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁴ Department of General Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

PMID: 36539988
DOI: 10.1111/ans.18179

Abstract

Background: Risk factors and outcomes associated with severe epistaxis are not well understood. This study explores the associations between epistaxis severity, comorbidities, use of antiplatelets or anticoagulants and management outcomes.

Methods: This is a retrospective cross-sectional study of all epistaxis cases presenting to the emergency department at a tertiary academic hospital from January 2016 to December 2019. Epistaxis severity was defined as mild (no intervention), moderate (required cautery and/or packing) and severe (clinical instability with reversal products, surgical or radiological intervention). Univariable and multivariable regression analyses were undertaken, with risk factors and management outcomes analysed according to severity.

Results: A total of 543 patients with epistaxis (54.2% male, mean age 74.4 ± 15.7 years) were included in this study, with 14.7% (80) having severe epistaxis. Of these presentations 216 (39.8%) were on antiplatelets, while 207 (38.1%) were on anticoagulants. In univariate analyses, clopidogrel use, hereditary haemorrhagic telangiectasia (HHT), haematological malignancy, bleeding disorders and chronic liver disease (CLD) were associated with moderate to severe epistaxis (P < 0.05), while the use of rivaroxaban was inversely associated severity (P = 0.002). Only HHT, haematological malignancy and CLD remained significant in multivariate models. Cautery as first-line management was infrequently utilized while anticoagulation was frequently withheld. A longer length of stay (1.1 days vs. 4.3 days; P < 0.001) and higher 2-week readmission rates (2.2% vs. 12.5%; P < 0.001) were noted with severe epistaxis compared with mild presentations.

Conclusion: Epistaxis severity is associated with certain clinical conditions and poor outcomes. Despite recommended guidelines, variations in first-line management were evident.

Keywords: ENT emergencies; NOAC; anticoagulation; antiplatelet; emergency medicine; epistaxis; management; otolaryngology; risk factors; surgery.

MeSH terms

Aged
Aged, 80 and over
Anticoagulants* / therapeutic use
Cross-Sectional Studies
Epistaxis* / epidemiology
Epistaxis* / etiology
Epistaxis* / therapy
Female
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors

Substances

Anticoagulants