The French Society of Otorhinolaryngology Head and Neck surgery issued some recommendations on the management of epistaxis in patients receiving anticoagulants, anti-platelet aggregants and anti-vitamin K drugs. This was a national multidisciplinary evidence-based concensus document. The group recommends review of the dosage of the antithrombotic drugs and the thrombotic risk of the patient. They observe that the risk of bleeding is increased with the use of packing and they recommend control of bleeding by digital pressure for 10 minutes and the preferential use of absorbable agents such as Surgicel or Nasopore. In case of failure a formal Merocel or conventional pack can be used and balloon tamponade may be needed in case of posterior epistaxis.
In patients with coronary stents under bimodal therapy (aspirin and P2Y12 inhibitor), it is advised to maintain therapy for at least one month after stenting and preferably for three months. It must be noted that stoppage of therapy does not restore coagulation for 10 days with such drugs, and for 2-5 days with anti-vitamin K.
For patients taking direct oral anticoagulants such as dabigatran in whom rapid coagulation is urgent, Idarucizumab can be administered. However for patients under anti-Xa there is no direct antidote yet and local measures should be maintained to control bleeding. In patients requiring endovascular emobilsation to control epistaxis, the anticoagulant therapy can be maintained. The recommendations include three informative practical working algorithms as well.
