• Main page
• About the journal
• Editorial board
• Subscription
• Information for contributors
• Editorial and Peer Review
• Issues archive
• Authors
• Articles
  • By alphabet
  • By category
• Blogs and comments

The journal is included into The list of leading scientific periodicals.

The journal is included into VINITI database and is registered in Electronic scientific library.

The journal is indexed by SCOPUS, Ulrich's International Periodicals Directory.

EBSCO

https://doi.org/10.14300/mnnc.2021.16069

Peculiarities of the management of epistaxis in hypertensive patients under antitrombotic therapy

[Original research] [Otorhinolaryngology]
Natalia Boiko;

The purpose of the study: to develop the optimal tactics for epistaxis management in hypertensive patients who are constantly taking antithrombotic drugs. The study involved 114 patients with arterial hypertension aged 58 to 77 years, hospitalized as an emergency for epistaxis. 44 patients (38,6 %) have never taken antithrombotic agents, 75 patients have taken anticoagulants and/or antiplatelet drugs over the previous 4–17 months: 18 out of 75 patients (24 %) have taken a combination of anticoagulant and antiplatelet agent (most often Сardiomagnyl and Warfarin), 35 patients (46,7 %) – Acetylsalicylic Acid (Aspirin, Aspirin Cardio, Cardiomagnyl), 14 patients (18,7 %) – Warfarin, 8 patients (10.6 %) – Clopidogrel. Patients were divided into 2 groups: 96 patients with single, and 18 patients with recurrent epistaxis. The following algorithm is proposed for the treatment of hypertensive patients with epistaxis during antithrombotic therapy. If the source of bleeding is detected at the initial examination, the bleeding vessel must be coagulated, in other cases nasal tamponade must be used. Antiplatelet drugs are discontinued until definitive hemostasis is achieved in all patients with epistaxis. Therapeutic approach for anticoagulants depends on the pattern of the bleeding. In cases of single epistaxis, dose adjustment of anticoagulants is not necessary. In patients with recurrent epistaxis the dose of warfarin is reduced by 20 % regardless of INR values.

Download

References:
1. Napalkov D. A., Sokolova A. A., Gabitova M. A., Uddin L. N. Anticoagulant Therapy in Difficult Patients with Atrial Fibrillation: When the Risks of Embolism and Bleeding Are Comparable. Ratsional’naya farmakoterapiya v kardiologii. – Rational pharmacotherapy in cardiology. 2018;14(5):785-789. (In Russ.).
https://doi.org/10.20996/1819-6446-2018-14-5-785-789
2. Stahovskaya L. V., Klochikhina O. A., Bogatyreva M. D., Koshel V. I., Mozheiko R. A. Stroke epidemiology indicators in Stavropol (according to population-based register data in 2009-2014). Meditsinskii vestnik Severnogo Kavkaza. – Medical News of North Caucasus. 2017;12(2):164-168. (In Russ.).
https://doi.org/10.14300/mnnc.2017.12046
3. Stahovskaya L. V., Klochikhina O. A., Bogatyreva M. D., Koshel V. I., Mozheiko R. A., Strakhov O. A. Сomparison of the incidence rate of stroke in the different regions of russian federation (populationbased register of stroke, 2009–2014). Meditsinskii vestnik Severnogo Kavkaza. – Medical News of North Caucasus. 2019;14(1):64-68. (In Russ.).
https://doi.org/10.14300/mnnc.2019.14051
4. Papayan L. P., Geltser I. V., Smirnova O. A., Golovina O. G., Kobilyanskaya V. A. Anticoagulation therapy – choice of strategy. Tromboz, gemostaz i reologiya. – Thrombosis, hemostasis and rheology. 2016;67(S3):315-316. (In Russ.).
5. Baturin V. A., Tsarukyan A. A. Role of genetic factors in therapy with indirect anticoagulants in ethnic groups of Stavropol region. Meditsinskii vestnik Severnogo Kavkaza. – Medical News of North Caucasus. 2015;10(2):166-170. (In Russ.).
https://doi.org/10.14300/mnnc.2015.10039
6. Ketova G. G., Barysheva V. O. Pharmacogenetic testing on warfarin and clopidorgel in conditions of a multiprofile hospital. Meditsinskii vestnik Severnogo Kavkaza. – Medical News of North Caucasus. 2017;12(3):253-255. (In Russ.).
https://doi.org/10.14300/mnnc.2017.12087
7. Kikidis D., Tsioufis K., Papanikolaou V., Zerva K., Hantzakos A. Is epistaxis associated with arterial hypertension? A systematic review of the literature. Eur. Arch. Otorhinolaryngol. 2014;271(2):237-243.
https://doi.org/10.1007/s00405-013-2450-z
8. Boiko N. V., Shatokhin Y. V. Pathogenesis of nasal bleeding in the patients presenting with arterial hypertension. Vestnik otorinolaringologii. – Bulletin of Otorhinolaryngology. 2015;80(5):41-45. (In Russ.).
https://doi.org/10.17116/otorino201580541-45
9. Boiko N. V., Panchenko S. N. The detection of the human papilloma virus during hyperplastic processes in the nose, ears and throat. Vestnik Otorinolaringologii. – Bulletin of Otorhinolaryngology. 2017;82(2);51-54. (In Russ.).
https://doi.org/10.17116/otorino201782251-54
10. Boiko N. V. Epistaxis and arterial hypertension: a pathogenic link. Vestnik Otorinolaringologii. – Bulletin of Otorhinolaryngology. 2021;86(1):72-77. (In Russ.).
https://doi.org/10.17116/otorino20218601172
11. Salivonchyk E. I., Yatskova O. V., Salivonchyk D. P. The peculiarities of nasal bleedings in cardiac patients. Otorinolaringologiya. Vostochnaya Evropa. – Otorhinolaryngology. Eastern Europe. 2014;16(3):73-82. (In Russ.).
12. Shakeel M., Trinidade A., Iddamalgoda T., Supriya M., Ah-See K. W. Routine clotting screen has no role in the management of epistaxis: reiterating the point. Eur. Arch. Otorhinolaryngol. 2010;267(10):1641-1644.
https://doi.org/10.1007/s00405-010-1243-x
13. L’Huillier V., Badet C., Tavernier L. Epistaxis complicating treatment by anti-vitamin K and new oral anticoagulants.Eur. Ann. Otorhinolaryngol. Head Neck Dis. 2018;135(4):231-235.
https://doi.org/10.1016/j.anorl.2018.04.006
14. Callejo F. J. G., Martínez C. B., González J. C., Beneyto P. M., Sanz M. M., Algarra J. M. Epistaxis and Dabigatran, a New Non-Vitamin K Antagonist Oral Anticoagulant. Acta Otorrinolaringol. Esp. 2014;65(6):346-354.
https://doi.org/10.1016/j.otoeng.2014.10.002
15. Guo J. G., Zhang Y., Huo J., Liu E., Hao J. Monitoring unbound warfarin in drug combination therapy by pharmacokinetics and fluorospectrometry. Chinese Herbal Medicines. 2019;11(1):92-97.
https://doi.org/10.1016/j.chmed.2018.10.002
16. Horton J. D., Bushwick B. Warfarin therapy: evolving strategies in anticoagulation. Am. Fam. Physician. 1999;59(3):635-646.
17. Lee S., Choi D., Jeong W. K., Song K. D., Min J. H. [et al.]. Frequency of hemorrhagic complications on abdominal CT in patients with warfarin therapy. Clinical Imaging. 2016;40(3):435-439.
https://doi.org/10.1016/j.clinimag.2015.12.005
18. Salivonchyk D. P., Dotsenko E. A., Salivonchyk E. I., Salivonchyk S. D. Anticoagulant therapy in otolaryngologist practice. Otorinolaringologiya. Vostochnaya Evropa. – Otorhinolaryngology. Eastern Europe. 2017;7(4):451-459. (In Russ.).
19. Vogel T., Geny B., Kaltenbach G., Lang P.-O. L’anticoagulation dans la fibrillation atriale du sujet âgé: point de vue du gériatre avec un focus sur les anticoagulants oraux directs. Rev. Med. Intern. 2015;36(1):22-30.
https://doi.org/10.1016/j.revmed.2014.08.005

Keywords: epistaxis, arterial hypertension, anticoagulants, antiplatelet drugs