(040) Anticoagulant Types and Epistaxis Risk

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

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Presenting Author(s)

AT

Aaron Tetreault, N/A

Medical Student
UTHSC College of Medicine
Memphis, Tennessee, United States
Camron M. Davies, MD

Resident Physician
Loma Linda University Health
Riverside, California, United States
KR

Kate Ramsey, MD

UTHSC, USA

Co-Author(s)

KR

Kate Ramsey, MD

UTHSC, USA

Senior Author(s)

Sanjeet V. Rangarajan, MD, MEng

Associate Professor of Otolaryngology - Head and Neck Surgery
University of Tennessee Health Science Center
Memphis, Tennessee, United States

Disclosure(s):

Aaron Tetreault, N/A: No relevant relationships to disclose.

Camron M. Davies, MD: No relevant relationships to disclose.

Sanjeet V. Rangarajan, MD, MEng: No relevant relationships to disclose.

Introduction: This study compares the rates of severe outcomes following epistaxis in patients taking three main categories of anticoagulants: direct oral anticoagulants (DOACs) such as factor Xa inhibitors, Vitamin K antagonists (VKAs) e.g. warfarin, or antiplatelet agents (APs) such as aspirin or clopidogrel.

Methods: A retrospective analysis was conducted using the TriNetX Research Platform linked to the Clinical Trials Network of Tennessee HER system, which predominantly consists of patients seen at tertiary medical centers in southwest Tennessee. Patients >50 years of age with epistaxis were identified with ICD-10CM-R04.0 and stratified into four cohorts based on anticoagulation exposure within 7 days preceding the first episode of epistaxis: DOACs (n=110), VKAs (n=60), APs (n=500) or none of the three (controls). Severe Outcomes were defined as any invasive intervention, transfusion, admission, or critical care based on ICD and CPT codes. Patients were propensity score-matched, and risk ratios were calculated.

Results: The VKA group (n=60) had the highest relative risk of Severe Outcome compared to their matched controls (50.0% vs 16.7%; risk ratio [RR]: 3, 95% confidence interval [95% CI]: 1.61-5.58, p < .001). DOACs (36.4% vs 18.2%; RR: 2, 95% CI: 1.254-3.191, p=.002) and APs (36.0% vs 18.0%; RR: 2, 95% CI:1.604-2.494, p < .001) had elevated but more intermediate risk of Severe Outcome compared to their controls. There were no differences in rate of subsequent emergency room visits.

Conclusions: All three exposure groups had a significantly higher risk of a Severe Outcomes following epistaxis. VKAs had the highest risk of Severe Outcomes, particularly regarding subsequent admissions or need for critical care. Our data suggest that patients treated with newer anticoagulant agents may have fewer serious complications due to epistaxis. Due to the apparent difference in side effect profiles, otolaryngologists may prefer DOACs and antiplatelet agents over warfarin.