{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:03:40Z","timestamp":1780031020428,"version":"3.53.1"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T00:00:00Z","timestamp":1733788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T00:00:00Z","timestamp":1733788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anticoagulants (AC) are associated with epistaxis in atrial fibrillation (AF) patients. Left atrial appendage occlusion (LAAO) is a treatment that allows AF patients to stop AC. The aim of this study is to evaluate the risk of developing epistaxis following LAAO versus direct oral anticoagulants (DOAC) and warfarin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study uses the TriNetX database as well as institutional records. The TriNetX database was searched for AF patients on a DOAC, warfarin, or treated with LAAO. Epistaxis odds ratios were compared 1 day\u20136 months and 6 months\u20133\u2009years following initiation of DOAC, warfarin, or LAAO. Records of LAAO patients at our institution were also reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The TriNetX query returned 1,185,862 patients. On TriNetX, LAAO patients had significantly higher odds of epistaxis likely due to antiplatelet therapy from 1\u2009day\u20136\u2009months compared to warfarin patients with DOAC patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). From 6 months\u20133\u2009years after treatment initiation, LAAO patients experience reduced odds of epistaxis and epistaxis requiring nasal packing compared to warfarin patients (OR: 0.69\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003; OR: 0.58\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0043). Institutionally, epistaxis resolved in 66% (8\/12) LAAO patients with a history of epistaxis with an average follow\u2010up of 1.5\u2009years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>LAAO decreased the frequency of epistaxis and epistaxis requiring nasal packing in AF patients on warfarin after 6\u2009months. Our institutional experience demonstrates long\u2010term improvement in epistaxis after LAAO for DOAC and warfarin patients. Additional studies need to be performed to account for dual antiplatelet following LAAO on epistaxis risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      3\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 135:1636\u20131641, 2025\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.31949","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T03:58:59Z","timestamp":1733889539000},"page":"1636-1641","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epistaxis Risk in Patients Treated With Left Atrial Appendage Occlusion Versus Oral Anticoagulation"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9221-1549","authenticated-orcid":false,"given":"Shreya","family":"Mandloi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Nunes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliott M.","family":"Sina","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Benedict","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chase","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6847-442X","authenticated-orcid":false,"given":"Alexander","family":"Duffy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Shing","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary D.","family":"Urdang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Iowa  Iowa City Iowa U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4476-0426","authenticated-orcid":false,"given":"Marc","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"Toskala","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy R.","family":"Rabinowitz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurston G.","family":"Nyquist","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfcm.JFCM_99_18"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-021-01983-z"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22764"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29417"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-018-5043-z"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192113802"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.10077"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2022.05.001"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.023"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2021.08.020"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15192"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/08998280.2023.2269354"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-22-00627"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"issue":"6","key":"e_1_2_6_16_1","first-page":"714","article-title":"The WATCHMAN device and post\u2010implantation anticoagulation management. A review of key studies and the risk of device\u2010related thrombosis","volume":"11","author":"Magdi M","year":"2021","journal-title":"Am J Cardiovasc Dis"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000818"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.08.013"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.02.047"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.31949","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.31949","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.31949","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:26:30Z","timestamp":1780028790000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.31949"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,10]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/lary.31949"],"URL":"https:\/\/doi.org\/10.1002\/lary.31949","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,10]]},"assertion":[{"value":"2024-07-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}