AB079. 133. Novel oral anticoagulants (NOACs): how does the popularisation of these anticoagulants affect the management of patients who experience epistaxis whilst taking them?

Background: The incidence of epistaxis peaks in the young and adults after the fifth decade. Patients in the latter group frequently have additional comorbidities that require anticoagulation, such as atrial fibrillation. Novel oral anticoagulants (NOACs) aim to provide the same efficacy as warfarin but with more predictable levels of anticoagulation and do not require regular monitoring. As a result, they are quickly becoming a popular alternative to warfarin for various indications including AF and DVT prophylaxis following specific surgeries. Although the management of patients who experience epistaxis whilst taking warfarin is well described, clear guidelines do not exist for the management of patients who specifically present with epistaxis following the initiation of a NOAC.

Methods: A ten-question survey was distributed to otolaryngology doctors to assess their basic knowledge about NOACs and evaluate their ability to manage patients who present with epistaxis whilst taking a NOAC.

Results: There was a significant lack of knowledge about the formulations amongst respondents with only 26% being able to identify the indication for prescribing a NOAC and less than 10% who were aware of the assays required to determine the plasma concentration of the drugs.

Conclusions: There is a need for ENT departments to develop guidelines for the management of patients who present with epistaxis whilst being anticoagulated with a NOAC. We present one such guideline to help in the management of these patients.

Keywords: Epistaxis management; novel oral anticoagulants (NOACs); anticoagulation