{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T13:05:31Z","timestamp":1762607131451},"reference-count":33,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T00:00:00Z","timestamp":1514332800000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215117002067_sec_a1\"><jats:title>Background:<\/jats:title><jats:p>The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215117002067_sec_a2\"><jats:title>Method:<\/jats:title><jats:p>A systematic review of the literature was performed using a standardised methodology and search strategy.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215117002067_sec_a3\"><jats:title>Results:<\/jats:title><jats:p>Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215117002067_sec_a4\"><jats:title>Conclusion:<\/jats:title><jats:p>The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215117002067","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T13:50:12Z","timestamp":1514382612000},"page":"1093-1107","source":"Crossref","is-referenced-by-count":17,"title":["Haematological factors in the management of adult epistaxis: systematic review"],"prefix":"10.1017","volume":"131","author":[{"given":"A","family":"Williams","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Biffen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Pilkington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Arrick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R J","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M E","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Birchall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2017,12,27]]},"reference":[{"key":"S0022215117002067_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.06.043"},{"key":"S0022215117002067_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2391"},{"key":"S0022215117002067_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100122613"},{"key":"S0022215117002067_ref31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1988.tb00275.x"},{"key":"S0022215117002067_ref25","doi-asserted-by":"publisher","DOI":"10.3310\/hta17100"},{"key":"S0022215117002067_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13580"},{"key":"S0022215117002067_ref3","doi-asserted-by":"publisher","DOI":"10.1186\/1916-0216-42-4"},{"key":"S0022215117002067_ref10","first-page":"542","article-title":"Warfarin and epistaxis: should warfarin always be discontinued?","volume":"22","author":"Srinivasan","year":"1997","journal-title":"Clin Otolaryngol"},{"key":"S0022215117002067_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30638-4"},{"key":"S0022215117002067_ref5","article-title":"Initial assessment in the management of adult epistaxis: systematic review","author":"Khan","journal-title":"J Laryngol Otol"},{"key":"S0022215117002067_ref20","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1002\/lary.20695","article-title":"Is severe epistaxis associated with acetylsalicylic acid intake?","volume":"120","author":"Soyka","year":"2010","journal-title":"Laryngoscope"},{"key":"S0022215117002067_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(97)70205-5"},{"key":"S0022215117002067_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.02.001"},{"key":"S0022215117002067_ref1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2009.01926.x"},{"key":"S0022215117002067_ref28","doi-asserted-by":"publisher","DOI":"10.1159\/000276741"},{"key":"S0022215117002067_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2011.08753.x"},{"key":"S0022215117002067_ref9","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215110001921"},{"key":"S0022215117002067_ref11","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215115003424"},{"key":"S0022215117002067_ref12","unstructured":"NICE Clinical Knowledge Summary. Anticoagulation: oral. In: https:\/\/cks.nice.org.uk\/anticoagulation-oral [30 May 2017]"},{"key":"S0022215117002067_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-015-1310-7"},{"key":"S0022215117002067_ref14","unstructured":"European Medicines Agency. Pradaxa\u00ae \u2013 Summary of Product Characteristics. 2015. In: http:\/\/www.ema.europa.eu\/docs\/en_GB\/document_library\/EPAR_-_Product_Information\/human\/000829\/WC500041059.pdf [30 May 2017]"},{"key":"S0022215117002067_ref15","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14344"},{"key":"S0022215117002067_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12107"},{"key":"S0022215117002067_ref17","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.otorri.2014.02.014","article-title":"Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant","volume":"65","author":"Callejo","year":"2014","journal-title":"Acta Otorrinolaringol Esp"},{"key":"S0022215117002067_ref18","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0000000000000042"},{"key":"S0022215117002067_ref19","doi-asserted-by":"publisher","DOI":"10.1177\/000348949810700808"},{"key":"S0022215117002067_ref21","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215113000492"},{"key":"S0022215117002067_ref27","unstructured":"NICE Guideline 24. Blood Transfusion. 2015. In: https:\/\/www.nice.org.uk\/guidance\/ng24 [30 May 2017]"},{"key":"S0022215117002067_ref33","unstructured":"NHS Blood and Transplant. Education. In: http:\/\/hospital.blood.co.uk\/patient-services\/patient-blood-management\/education\/ [2 August 2017]"},{"key":"S0022215117002067_ref23","unstructured":"Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. National Blood Transfusion Committee Responses and Recommendations. In: http:\/\/www.transfusionguidelines.org\/uk-transfusion-committees\/national-blood-transfusion-committee\/responses-and-recommendations [30 May 2017]"},{"key":"S0022215117002067_ref22","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14423"},{"key":"S0022215117002067_ref24","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318292cc54"},{"key":"S0022215117002067_ref30","first-page":"1","article-title":"Epistaxis","volume":"77","author":"Petruson","year":"1974","journal-title":"A clinical study with special reference to fibrinolysis. Acta Otolaryngol Suppl"}],"container-title":["The Journal of Laryngology &amp; Otology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0022215117002067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T23:26:23Z","timestamp":1603581983000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0022215117002067\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12]]},"references-count":33,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["S0022215117002067"],"URL":"https:\/\/doi.org\/10.1017\/s0022215117002067","relation":{},"ISSN":["0022-2151","1748-5460"],"issn-type":[{"value":"0022-2151","type":"print"},{"value":"1748-5460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12]]}}}