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Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta-analysis
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  • Petar Stanković,
  • Stephan Hoch,
  • Stefan Rudhart,
  • Danilo Obradovic,
  • Nikolaos Dagres,
  • Thomas Wilhelm
Petar Stanković
Sana Kliniken Leipziger Land GmbH

Corresponding Author:petar.stankovic@sana.de

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Stephan Hoch
Philipp University
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Stefan Rudhart
Philipp University
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Danilo Obradovic
Leipzig Heart Centre University Hospital Clinic for Cardiology
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Nikolaos Dagres
Leipzig Heart Centre University Hospital Clinic for Cardiology
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Thomas Wilhelm
Sana Kliniken Leipziger Land GmbH
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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.
03 Sep 2021Submitted to Clinical Otolaryngology
20 Sep 2021Submission Checks Completed
20 Sep 2021Assigned to Editor
26 Sep 2021Reviewer(s) Assigned
24 Oct 2021Review(s) Completed, Editorial Evaluation Pending
25 Oct 2021Editorial Decision: Revise Major
28 Oct 20211st Revision Received
30 Oct 2021Submission Checks Completed
30 Oct 2021Assigned to Editor
01 Nov 2021Reviewer(s) Assigned
02 Nov 2021Review(s) Completed, Editorial Evaluation Pending
07 Nov 2021Editorial Decision: Accept
Mar 2022Published in Clinical Otolaryngology volume 47 issue 2 on pages 255-263. 10.1111/coa.13898