{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:13:33Z","timestamp":1788167613929,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Risk factors and outcomes associated with severe epistaxis are not well understood. This study explores the associations between epistaxis severity, comorbidities, use of antiplatelets or anticoagulants and management outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective cross\u2010sectional study of all epistaxis cases presenting to the emergency department at a tertiary academic hospital from January 2016 to December 2019. Epistaxis severity was defined as mild (no intervention), moderate (required cautery and\/or packing) and severe (clinical instability with reversal products, surgical or radiological intervention). Univariable and multivariable regression analyses were undertaken, with risk factors and management outcomes analysed according to severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 543 patients with epistaxis (54.2% male, mean age 74.4\u2009\u00b1\u200915.7\u2009years) were included in this study, with 14.7% (80) having severe epistaxis. Of these presentations 216 (39.8%) were on antiplatelets, while 207 (38.1%) were on anticoagulants. In univariate analyses, clopidogrel use, hereditary haemorrhagic telangiectasia (HHT), haematological malignancy, bleeding disorders and chronic liver disease (CLD) were associated with moderate to severe epistaxis (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05), while the use of rivaroxaban was inversely associated severity (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.002). Only HHT, haematological malignancy and CLD remained significant in multivariate models. Cautery as first\u2010line management was infrequently utilized while anticoagulation was frequently withheld. A longer length of stay (1.1\u2009days vs. 4.3\u2009days; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and higher 2\u2010week readmission rates (2.2% vs. 12.5%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) were noted with severe epistaxis compared with mild presentations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Epistaxis severity is associated with certain clinical conditions and poor outcomes. Despite recommended guidelines, variations in first\u2010line management were evident.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18179","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T05:58:37Z","timestamp":1671602317000},"page":"555-560","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Risk factors and management outcomes in epistaxis: a tertiary centre experience"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5903-9765","authenticated-orcid":false,"given":"Jed M.","family":"Hughes","sequence":"first","affiliation":[{"name":"Department of ENT Head Neck Surgery, Austin Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing Mei","family":"Teh","sequence":"additional","affiliation":[{"name":"Department of ENT Head Neck Surgery, Austin Health  Melbourne Victoria Australia"},{"name":"Department of Otolaryngology, Head and Neck Surgery, Monash Health; Faculty of Medicine, Nursing and Health Sciences Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron J.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of ENT Head Neck Surgery, Austin Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry H.","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Central Clinical School Monash University  Melbourne Victoria Australia"},{"name":"Department of General Medicine Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ar Kar","family":"Aung","sequence":"additional","affiliation":[{"name":"Department of General Medicine Alfred Hospital  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26683"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819889955"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12024"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.2906"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20818"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2017.07.021"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29417"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12904"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i38.13993"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215117002018"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2016.01.003"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.976"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1988.01860200046014"},{"key":"e_1_2_8_15_1","first-page":"381","article-title":"Epistaxis: prevailing factors and treatment","volume":"13","author":"Dal Secchi MM","year":"2009","journal-title":"Int Arch. 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