Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis
patients: a systematic review and meta-analysis
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.