Research Article
PDF EndNote BibTex RIS Cite

Ciddi Epistaksis olan Hastalarda Rutin Koagülasyon Teslerinin Değerlendirmesi

Year 2021, Volume 3, Issue 3, 210 - 213, 01.09.2021
https://doi.org/10.37990/medr.904878

Abstract

Amaç: Epistaksis yönetiminde koagülasyon testlerinin gerekli olmadığını gösteren çalışmalar mevcuttur. Bu çalışmanın amacı, müdahale gerektiren ciddi burun kanamalarında pıhtılaşma testlerinin gerekli olup olmadığını ve ilaçlarla ilişkisini araştırmaktır..
Materyal ve Metot: Çalışmaya Acil Servis’e burun kanaması ile başvurmuş 16 yaş üstü, anterior veya posterior burun tamponu konulan veya nazal mukozaya koterizasyon uygulnan hastalar dahil edildi. Hastalara ait demografik veriler, tam kan sayımı, koagülasyon testleri, kullandığı antikoagülan ve anti-trombosit ilaçlar, kanamayı durdurmak için kullanılan yöntem ve kan transfüzyonu veya koagülasyon bozukluğu için kan ürünü alıp almadığı kaydedildi.
Bulgular: Toplam 469 hastadan 141 (%30,2)’inin koagülasyon testlerinin çalışıldığı bulundu. Antikoagülan kullanan hastaların PT, aPTT ve INR değerleri anlamlı olarak yüksek bulunurken (sırasıyla p<0,001, p=0,003, p<0,001) trombosit ve hemoglobin değerlerinin anti-trombosit ve antikoagülan kullanımı ile ilişkili olmadığı bulundu (sırasıyla p=0.304, p=0.098). Hastalar herhangi bir koagülasyon veya kanama parametresinde bozulma olan ve olmayan olarak iki gruba ayrıldı. Hemoglobin değerleri açısından gruplar arasında anlamlı fark bulunurken (p=0,006), kan transfüzyonu veya koagülasyon bozukluğu için kan ürünü replasmanına ihtiyaç duyan hasta saptanmadı.
Sonuç: Konservatif yöntemlerle durdurulamayan epistaksisi olan ve antitrombosit ilaç kullanan hastalarda tedavide fark yaratmadığı için rutin pıhtılaşma testi yapılmasına gerek yoktur. Antikoagülan kullanan hastalarda sonuçlara göre pıhtılaşma testleri yapılmayabilir.

References

  • 1. Purkey MR, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis. Laryngoscope 2014; 124(9):2028–33.
  • 2. Riviello RJ. Otolaryngologic procedures. In: Clinical Procedures in Emergency Medicine, 4th, Roberts JR, Hedges JR (Eds), WB Saunders, Philadelphia 2004; p.1300.
  • 3. Awan MS, Iqbal M, Imam SZ. Epistaxis: when are coagulation studies justified? Emerg Med J 2008; 25(3):156–157.
  • 4. Horton JD, Bushwick B Warfarin therapy: evolving strategies in anticoagulation. Am Fam Physician 1999; 59:635–646.
  • 5. Béquignon E, Teissier N, Gauthier A, et al. Emergency department care of childhood epistaxis. Emerg Med J. 2017; 34:543–548.
  • 6. Beck R, Sorge M, Schneider A, Dietz A: Current approaches to epistaxis treatment in primary and secondary care. Dtsch Arztebl Int 2018; 115: 12–22.
  • 7. Nitu IC, Perry DJ, Lee CA. Clinical experience with the use of clotting factor concentrates in oral anticoagulation reversal. Clin Lab Haematol. 1998; 20(6):363.
  • 8. Murer K, Ahmad N, Roth BA, Holzmann D, Soyka MB. THREAT helps to identify epistaxis patients requiring blood transfusions. Journal of Otolaryngology. Head and Neck Surgery 2013; 42:4.
  • 9. Barlow DW, Deleyiannis WB, Pinczower EF. Effectiveness of surgical management of epistaxis at a tertiary care center. Laryngoscope 1997; 107(1):21–24.

Evaluation of Routine Coagulation Testing Requirements in Patients with Severe Epistaxis

Year 2021, Volume 3, Issue 3, 210 - 213, 01.09.2021
https://doi.org/10.37990/medr.904878

Abstract

Aim: There are studies about coagulation parameters are not required in the management of epistaxis. The aim of the present study was to investigate whether or not coagulation tests are required and its relationship with medications in severe epistaxis cases that require intervention.
Material and Method: The patients above 16 years who had presented to emergency department due to epistaxis, who had undergone anterior/posterior nasal packing or electro-cautery to the nasal mucosa were included the study. The demographic characteristics, blood count, coagulation test, anti-platelet and anti-coagulant medications, the procedures carried out for stopping bleeding, whether reversal treatment or blood transfusion was needed were recorded.
Results: A total of 469 patients, it was found that coagulation parameters had been tested in 141(30.2%). While PT, aPTT and INR values of the anti-coagulant using patients were significantly higher(p<0.001, p=0.003, p<0.001, respectively), the platelet and hemoglobin values were not found to be associated with anti-platelet drug and anti-coagulant use(p=0.304, p=0.098, respectively). The patients were allocated to two groups as those any parameter of whom was impaired or not. While a significant difference was found between the groups with regard to hemoglobin values(p=0.006), no patients were determined to need reversal treatment or hemoglobin replacement.
Conclusion: Routine coagulation testing is not required for patients who have epistaxis that cannot be stopped with conservative methods and who are using anti-platelet drugs as it does not lead to a difference in treatment. Coagulation tests may not be performed in patients who use anti-coagulants based on the results.

References

  • 1. Purkey MR, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis. Laryngoscope 2014; 124(9):2028–33.
  • 2. Riviello RJ. Otolaryngologic procedures. In: Clinical Procedures in Emergency Medicine, 4th, Roberts JR, Hedges JR (Eds), WB Saunders, Philadelphia 2004; p.1300.
  • 3. Awan MS, Iqbal M, Imam SZ. Epistaxis: when are coagulation studies justified? Emerg Med J 2008; 25(3):156–157.
  • 4. Horton JD, Bushwick B Warfarin therapy: evolving strategies in anticoagulation. Am Fam Physician 1999; 59:635–646.
  • 5. Béquignon E, Teissier N, Gauthier A, et al. Emergency department care of childhood epistaxis. Emerg Med J. 2017; 34:543–548.
  • 6. Beck R, Sorge M, Schneider A, Dietz A: Current approaches to epistaxis treatment in primary and secondary care. Dtsch Arztebl Int 2018; 115: 12–22.
  • 7. Nitu IC, Perry DJ, Lee CA. Clinical experience with the use of clotting factor concentrates in oral anticoagulation reversal. Clin Lab Haematol. 1998; 20(6):363.
  • 8. Murer K, Ahmad N, Roth BA, Holzmann D, Soyka MB. THREAT helps to identify epistaxis patients requiring blood transfusions. Journal of Otolaryngology. Head and Neck Surgery 2013; 42:4.
  • 9. Barlow DW, Deleyiannis WB, Pinczower EF. Effectiveness of surgical management of epistaxis at a tertiary care center. Laryngoscope 1997; 107(1):21–24.

Details

Primary Language English
Subjects Surgery
Journal Section Original Articles
Authors

Bora ÇEKMEN> (Primary Author)
KARABÜK ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0003-3348-8375
Türkiye


Öner BOZAN>
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL OKMEYDANI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0002-4195-2601
Türkiye


Şeref Emre ATİŞ>
Mersin Şehir Hastanesi
0000-0002-5094-6000
Türkiye


Sevilay Sema ÜNVER>
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL OKMEYDANI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0002-5074-3545
Türkiye


Kamil KOKULU>
AKSARAY ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-6132-0898
Türkiye


Asım KALKAN>
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL OKMEYDANI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0002-5800-0201
Türkiye

Publication Date September 1, 2021
Published in Issue Year 2021, Volume 3, Issue 3

Cite

Vancouver Çekmen B. , Bozan Ö. , Atiş Ş. E. , Ünver S. S. , Kokulu K. , Kalkan A. Evaluation of Routine Coagulation Testing Requirements in Patients with Severe Epistaxis. Medical Records. 2021; 3(3): 210-213.

      17741     17754      26344     16257         17755

  16259    16338               16321.      20130            

    17740.       18599                 18605       19260  20095



Chief Editors
Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Turkey

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Turkey

E-mail: medrecsjournal@gmail.com

Contact
Publisher: Effect Publishing & Agency
Phone: + 90 (553) 610 67 80
E-mail: info@effectpublishing.com