Comparing Epistaxis Rates in Patients on Warfarin vs DOACs
Author Information
Author(s): Burke Khristian S., Kong Xiaowen, Haymart Brian, DeCamillo Debbie, Ali Mona, Barnes Geoff, Kaatz Scott
Primary Institution: Central Michigan University College of Medicine
Hypothesis
Do patients taking warfarin have higher rates of clinically relevant epistaxis compared to those taking direct oral anticoagulants (DOACs)?
Conclusion
Patients receiving warfarin had significantly higher rates of clinically relevant epistaxis compared to those on DOACs.
Supporting Evidence
- Patients on warfarin had an observed rate of 2.06 epistaxis events per 100 patient-years.
- The DOAC group had an observed rate of 0.75 epistaxis events per 100 patient-years.
- 18 (4.8%) of ED visits in the warfarin group met criteria for major bleeding.
- 93 (24.6%) of ED visits in the warfarin group resulted in hospital admission.
Takeaway
This study found that people taking warfarin had more nosebleeds that needed emergency treatment than those taking newer blood thinners called DOACs.
Methodology
The study analyzed data from a quality improvement registry comparing rates of epistaxis in patients on warfarin and DOACs.
Potential Biases
There is a risk of confounding bias as patients were not randomized.
Limitations
The study was limited to patients in Michigan and was observational, which may introduce confounding bias.
Participant Demographics
The study included 10,557 patients on warfarin and 3,889 on DOACs, with a diverse demographic including 21% to 24% non-White participants.
Statistical Information
P-Value
<0.0001
Confidence Interval
95% CI, 1.8, 2.2
Statistical Significance
p<0.0001
Digital Object Identifier (DOI)
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