Úvod: Epistaxe je cévní krvácení v oblasti nosní sliznice. Antikoagulační terapie zvyšuje četnost záchytu epistaxe. Antikoagulancia se dle účinku dělí na přímá a nepřímá. Přímá antikoagulancia jsou především NOAC (novel oral anticoagulants). Do skupiny nepřímých antikoagulancií řadíme warfarin. Metodika: Retrospektivní studie hodnotí přínos zavedení NOAC pro otorinolaryngologii v souvislosti se vznikem závažné epistaxe. Srovnává počet hospitalizovaných dospělých pacientů s epistaxí v průběhu 6 let při léčbě warfarinem a NOAC, kteří byli hospitalizováni s epistaxí na ORL oddělení Krajské nemocnice Tomáše Bati (KNTB) ve Zlíně v letech 2017–2022. Dále byl sledován věk pacientů a pohlaví. Závažnost epistaxe byla hodnocena ve vztahu k použité nosní tamponádě a celkové anestezii. Byl popsán vztah s daty Státního ústavu pro kontrolu léčiv (SÚKL) o počtu vydaných antikoagulačních léčiv. Výsledky: Během 6 let bylo pro epistaxi hospitalizováno celkem 221 pacientů, 32 užívalo warfarin a 20 NOAC. Průměrný věk pacientů s antikoagulační léčbou byl 78 let, v zastoupení 61,5 % mužů a 38,5 % žen. V průběhu let vidíme pokles počtu epistaxí u pacientů s warfarinem, s NOAC je počet stacionární. Dle statistiky SÚKL o dodaných preparátech do lékáren v roce 2017 a 2022 došlo ke snížení preskripce warfarinu o 44 % a naopak ke zvýšení NOAC až o 170 %. Závěr: Poklesem preskripce warfarinu pozorujeme snížený počet hospitalizací se závažnou epistaxí s tímto typem léčby. Naopak nárůst antikoagulační terapie preparáty ze skupiny NOAC nevede ke zvýšení záchytu epistaxí, z čehož profituje i ORL obor.
Introduction: Epistaxis is vascular bleeding in the area of the nasal mucosa. Anticoagulation therapy increases the incidence of epistaxis. Anticoagulants are divided into direct and indirect depending on their effects. Direct anticoagulants are primarily novel oral anticoagulants (NOACs). Warfarin belongs to the group of indirect anticoagulants. Methodology: The retrospective study evaluates the benefit of the introduction of NOACs for otorhinolaryngology in connection with the occurrence of severe epistaxis. A comparison was done of the number of hospitalized adult patients with epistaxis over the course of 6 years during warfarin and NOAC treatment who were hospitalized with epistaxis at the ENT department of KNTB in Zlín between 2017–2022. The patient’s age and gender were also monitored. The severity of epistaxis was evaluated in relation to the used nasal packing and general anesthesia. The relationship with SÚKL data on the number of issued anticoagulant drugs is described. Results: During 6 years, a total of 221 patients were hospitalized for epistaxis, 32 were taking warfarin, and 20 were taking NOACs. The average age of patients with anticoagulant treatment was 78 years, represented by 61.5% men and 38.5% women. Over the years, we see a decrease in the number of epistaxis cases in warfarin patients; with NOACs the number is stationary. According to SÚKL statistics on preparations delivered to pharmacies in 2017 and 2022, there was a decrease in the prescription of warfarin by 44%; on the contrary, an increase of NOAC was up to 170%. Conclusion: With the decrease in the prescription of warfarin, we observe a reduced number of hospitalizations with severe epistaxis with this type of treatment. On the contrary, the increase in anticoagulation therapy with preparations from the NOAC group does not lead to an increase in the incidence of epistaxis, which also benefits the ENT field.
- MeSH
- Anticoagulants * pharmacology classification therapeutic use MeSH
- Epistaxis * diagnosis drug therapy MeSH
- Hospitalization MeSH
- Drug Prescriptions MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Endotamponade classification methods MeSH
- Warfarin pharmacology therapeutic use MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- MeSH
- Electrocoagulation methods MeSH
- Epistaxis * classification therapy MeSH
- Humans MeSH
- Therapeutics * classification methods MeSH
- Endotamponade methods adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Nasal Surgical Procedures classification MeSH
- Surgical Procedures, Operative * classification MeSH
- Endoscopy classification methods MeSH
- Epistaxis * surgery diagnostic imaging MeSH
- Contraindications, Procedure MeSH
- Humans MeSH
- Nose surgery diagnostic imaging MeSH
- Nasal Cavity surgery diagnostic imaging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Epistaxis * etiology drug therapy therapy MeSH
- Hypertension pathology MeSH
- Hematologic Diseases pathology MeSH
- Hemorrhage therapy MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Balloon Occlusion MeSH
- Biocompatible Materials classification therapeutic use MeSH
- Epistaxis nursing therapy MeSH
- Hemostatic Techniques * classification nursing MeSH
- Pharmaceutical Preparations classification MeSH
- Humans MeSH
- Occlusive Dressings MeSH
- Polyvinyl Alcohol therapeutic use MeSH
- Endotamponade * classification methods MeSH
- Gelatin therapeutic use MeSH
- Check Tag
- Humans MeSH
- MeSH
- Electrocoagulation * classification methods adverse effects MeSH
- Epistaxis * pathology therapy MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Arteries surgery MeSH
- Nasal Surgical Procedures * classification methods adverse effects MeSH
- Epistaxis * surgery MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
