vitamin-k-semiquinone-radical and Epistaxis

Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiological and haematological guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome.. A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data were analysed and standardised mean difference (SMD) was calculated according to Hedges' g. Dichotomous data were analysed, and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I. A total of eight reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD = -0.22, 95% CI-0.42 to -0.02, p = .03) and a significantly higher rate of posterior bleeding in the VKA group (OR = .39, 95% CI 0.23 to 0.68, p = .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion or surgical intervention (p = .57, .12, .57 and .38 respectively) were found.. According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

Topics: Administration, Oral; Anticoagulants; Epistaxis; Hospitalization; Humans; Vitamin K

To assess any differences in severity and management of epistaxis when complicating treatment by anti-vitamin K (AVK) or by new oral anticoagulants (NOAC).. All patients admitted to the ENT department of a University Hospital Center for epistaxis under oral anticoagulation therapy between January 2010 and June 2015 were included in a retrospective study. Severity was assessed in terms of management and of hemoglobin level at admission. Two groups were distinguished: treatment by AVK or by NOAC.. One hundred and thirty-four patients were included: 126 under AVK and 8 under NOAC. There was a significant difference in mean hospital stay: 4.5 days for AVK versus 3.5 days for NOAC (P=0.019; 95% CI [0.1921; 0.8907]). There were no significant differences for the other severity criteria. None of the patients died.. Admission rates for epistaxis complicating NOAC therapy was low, and much lower than in case of AVK. Bleeding severity was equivalent with both treatments. NOACs significantly reduce hospital stay. Contrary to the study hypothesis, epistaxis is less serious when complicating NOAC than AVK therapy.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Epistaxis; Female; Humans; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Vitamin K

A 17-year-old woman, with a history of three operations on the upper gut in early life and intermittent diarrhoea, presented with a history of epistaxis and leg ecchymosis for the previous 3 months. Initial investigation revealed mild anaemia, low serum albumin, moderately elevated aminotransferases and an exceedingly prolonged prothrombin time (PT) which was promptly shortened to normal by intravenous vitamin K. Additional investigations revealed a grossly abnormal glucose hydrogen breath test, a dilated duodenum and deficiencies of vitamins A, D and E. Repeated courses of antimicrobial agents caused prompt but transient shortening of PT and eventually a duodenal-jejunal anastomosis was performed. Since then, up to 36 months later, the patient has been in good general health and PT has been consistently normal with no vitamin K supplementation. Small intestinal bacterial overgrowth has previously been associated with several conditions but this is the first description of its association with vitamin K-responsive coagulopathy.

Topics: Adolescent; Anastomosis, Surgical; Blind Loop Syndrome; Blood Coagulation Disorders; Breath Tests; Dietary Supplements; Ecchymosis; Epistaxis; Female; Glucose; Humans; Hydrogen; Leg; Time Factors; Treatment Outcome; Vitamin K

The goal of the present study was to analyze the risk factors for epistaxis in patients followed in general practices in Germany.. The current study sample included patients aged 18 years or older who received a first epistaxis diagnosis between January 2012 and December 2016 (index date). Epistaxis patients and controls without epistaxis were matched (1:1) on the basis of age, gender, insurance status and physician.. A total of 16,801 patients with epistaxis and 16,801 control subjects were included in this study. Of the subjects, 53.2% were men, and the mean age was 59.6 years (SD=21.2 years). Epistaxis was found to be positively associated with hypertension, obesity, chronic sinusitis, other disorders of the nose and nasal sinuses, anxiety disorder, and adjustment disorder (ORs ranging from 1.13 to 1.44). Epistaxis was also associated with the prescription of vitamin K antagonists, preparations from the heparin group, platelet aggregation inhibitors excluding heparin, direct thrombin inhibitors, direct factor Xa inhibitors, other antithrombotic agents, selective serotonin reuptake inhibitors and nasal steroids (ORs ranging from 1.15 to 3.55).. Overall, epistaxis risk is increased by multiple medical and psychiatric disorders. Several antithrombotic and nasal steroid therapies are also associated with this risk.

Topics: Adjustment Disorders; Adult; Aged; Anxiety Disorders; Case-Control Studies; Epistaxis; Female; Fibrinolytic Agents; Germany; Glucocorticoids; Humans; Hypertension; Male; Middle Aged; Obesity; Platelet Aggregation Inhibitors; Risk Factors; Sinusitis; Vitamin K

The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short- but also in a long-term perspective.. This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects.

Topics: Adult; Aspirin; Cohort Studies; Epistaxis; Female; Fibrinolytic Agents; Humans; Long Term Adverse Effects; Male; Middle Aged; Nasal Surgical Procedures; Prognosis; Retrospective Studies; Risk Factors; Secondary Prevention; Severity of Illness Index; Switzerland; Vitamin K

Vitamin K deficiency bleeding (VKDB), formerly known as hemorrhagic disease of the newborn (HDN), is a bleeding disorder in neonates that is caused by inadequate serum levels of vitamin K. Vitamin K is a nutrient essential for adequate function of the coagulation cascade. Certain internal and external factors place newborn infants at higher risk for VKDB. Therefore, vitamin K prophylaxis has become the standard of care for newborns. Although the American Academy of Pediatrics recommends the administration of vitamin K to newborns, some parents are choosing to withhold vitamin K administration at birth. This case study describes an infant who developed VKDB in the absence of vitamin K prophylaxis. Although parents ultimately have the right to choose whether or not to administer vitamin K, as healthcare professionals, it is important to provide education regarding the potential complications of withholding vitamin K and the signs of VKDB if vitamin K prophylaxis at birth is withheld.

Topics: Antifibrinolytic Agents; Chemoprevention; Epistaxis; Female; Humans; Infant, Newborn; Parents; Treatment Refusal; Umbilical Cord; Vitamin K; Vitamin K Deficiency Bleeding

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Coagulation Disorders; Contusions; Epistaxis; Female; Hematemesis; Humans; Male; Middle Aged; Vitamin K; Vitamins; Warfarin

Topics: 4-Hydroxycoumarins; Adult; Anticoagulants; Diagnosis, Differential; Epistaxis; Female; Hematemesis; Humans; Partial Thromboplastin Time; Pesticides; Poisoning; Prothrombin Time; Thrombosis; Unconsciousness; Vitamin K; Vitamin K Deficiency

Topics: Anticoagulants; Drug Interactions; Epistaxis; Female; Humans; Middle Aged; Patient Compliance; Patient Education as Topic; Risk Factors; Vitamin K; Warfarin

Topics: Anticoagulants; Epistaxis; Humans; International Normalized Ratio; Male; Middle Aged; Prothrombin Time; Vitamin K; Warfarin

To determine the prevalence of vitamin K deficiency bleeding in the Netherlands, in order to evaluate the efficacy of recommendations on vitamin K prophylaxis.. Descriptive.. University Hospital Nijmegen, the Netherlands.. Active surveillance of vitamin K deficiency bleeding (VKDB) by the Dutch Paediatric Surveillance Unit from October 1, 1992 to December 31, 1994.. Of the 19 reported cases 5 could be validated as late vitamin K deficiency bleeding: 2 idiopathic cases, and 3 secondary cases due to liver disorders. One case had intracranial bleeding and died. None of the cases had received exactly the recommended prophylaxis. The incidence of late VKDB was calculated to be 1.1/100,000 live births. Before vitamin K prophylaxis was recommended the incidence was estimated to be 7/100,000.. The present Dutch recommendations for prevention of vitamin K deficiency bleeding-1 mg vitamin K at birth and thereafter for breastfed infants daily 25 micrograms from 2 to 13 weeks-appear effective.

Topics: Cerebral Hemorrhage; Epistaxis; Hematemesis; Humans; Infant; Infant, Newborn; Vitamin K; Vitamin K Deficiency

A six year old Percheron mare was presented with a history of spontaneous unilateral epistaxis of 24 hours duration. The blood one stage prothrombin and partial thromboplastin times were markedly prolonged. A diagnosis of moldy sweetclover poisoning was made on the basis of the history and clinical and laboratory findings. A single whole blood transfusion and four daily intravenous injections of vitamin K(3) proved to be a successful treatment.

Topics: Animals; Dicumarol; Epistaxis; Female; Horse Diseases; Horses; Plant Poisoning; Vitamin K

Fourteen cases of ASA induced hypoprothrombinemic bleeding, including three patients reported by the authors, are reviewed. Predisposing factors toward bleeding include malnutrition and malabsorption syndrome. Although the bleeding is usually benign, it may be serious on occasion. The importance of this rarely considered cause of ASA associated bleeding lies in the fact that it is readily corrected with Vitamin K.

Topics: Adult; Aged; Arthritis, Rheumatoid; Aspirin; Epistaxis; Female; Humans; Hypoprothrombinemias; Malabsorption Syndromes; Male; Middle Aged; Nutrition Disorders; Vitamin K

Topics: Coumarins; Epistaxis; Humans; Vitamin K

Topics: Dietary Proteins; Epistaxis; Female; Food Analysis; Glycine max; Hemorrhage; Humans; Hypoprothrombinemias; Infant; Infant Nutritional Physiological Phenomena; Vitamin K

Topics: Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Epistaxis; Female; Hemostatics; Humans; Male; Middle Aged; Procaine; Rabbits; Thrombin; Vitamin K

Topics: Antifibrinolytic Agents; Ascorbic Acid; Epistaxis; Hemorrhage; Hemostatics; Humans; Nose; Prothrombin; Vitamin K; Vitamins