Full abstract
Management of epistaxis in patients taking NOACs compared to warfarin
Presenter: Charn Gill
Coauthors: S Tzortis, S Goh, S Anari
Institute: Birmingham Heartlands Hospital

There are an increasing number of patients who are requiring anticoagulation for various conditions such as atrial fibrillation resulting in more patients taking new anticoagulation medication (NOACs). Epistaxis is a known side effect of these anticoagulants however little is known whether NOACs are resulting in different length of hospital stay, management or re-admission rates.
A retrospective review of ENT admissions was conducted over a ten-month period of patients with epistaxis on warfarin or NOACs. The data gathered included basic demographics, length of stay, reason for anticoagulation, blood results, management and whether re-admission occurred within one month. Data was collcted and analysed in Microsoft Excel.
Preliminary results of 50 patients were analysed, 31 taking warfarin and 19 taking NOACs. The average length of stay was 2 days with those on warfarin averaging at 2.09 and those on NOACs at 1.84. The average level in patients taking warfarin was 7.2x109/L compared to 0.25x109/L in NOACs. 87% of patients on warfarin were packed and 89% of those on NOACs. 97% of patients on warfarin were restarted on discharge whereas only 78.9% of those on NOACs were restarted. 3% of patients re-attended on warfarin compared to 19% of those on NOACs.
In conclusion the length of stay does not significantly vary between patients taking warfarin and NOACs, however the change in haemoglobin taking NOACs compared to warfarin is lower. Management is generally similar with no patients requiring theatre however rates of re-admission are much higher in those taking NOACs.