항응고제와 항혈소판제 복용 환자에서의 비출혈

Abstract

Background and Objectives : Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet medication. The use of theses medications have been increasing markedly in Korea over the recent years due to an aging society. This retrospective study assessed the prevalence of epistaxis in patients taking anticoagulant and antiplatelet medication and monitored differences in patients' clinical courses. Materials and Methods : A retrospective chart review was performed for consecutive patients referred to the ENT department with epistaxis from the emergency room over a one-year period from July, 2010 to June, 2011. Emergency room's and ENT OPD's medical records were reviewed to investigate clinical courses. Results : Over the study period, 188 patients presented to the emergency room with epistaxis, this represented 0.6% of all emergency attendances. Of the patients, 143 patients(76%) were referred on to the ENT department, 24% of whom were currently taking anticoagulant or antiplatelet medication. There were 5 patients taking Warfarin, 32 taking Aspirin, 3 taking Clopidogrel, and six of them were taking more than one medication simultaneously. Patients that were taking medication were made up of older ages and had higher prevalence rate of hypertension. There was no difference in the bleeding site, the recurrence rate, hospitalization and duration of in-patient stay, and method of treatment between the groups. Most common method of treatment was electrical cauterization under nasal endoscope regardless of the medications. Conclusions : Patients with epistaxis taking anticoagulant or antiplatelet medication have been increasing recently, so a better understanding of such medication's prevalence and mechanism of action may enable more effective management of these patients. Nasal endoscopy with suction bovie enabled precise localization of the epistaxis and prompt focused management rather than nasal packing.