# Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics

## TL;DR

This study shows that patients using antithrombotics have more maxillofacial bleeding symptoms, but these symptoms still predict facial fractures in both users and non-users.

## Contribution

The study identifies specific maxillofacial haemorrhagic symptoms as predictors of fractures in patients using and not using antithrombotics.

## Key findings

- Patients using antithrombotics had higher frequencies of peri-orbital hematoma, raccoon eyes, and subconjunctival ecchymoses.
- Maxillofacial haemorrhagic symptoms were significant predictors of fractures in both antithrombotic users and non-users.
- Intra-oral hematoma was a strong predictor of fractures, especially in non-users (OR=7.1) and even more so in users (OR=22.0).

## Abstract

To investigate the effect of antithrombotics on the occurrence of maxillofacial haemorrhagic symptoms, and to determine if these haemorrhagic symptoms are predictors of maxillofacial fractures.

A prospective cohort study was conducted of consecutive patients with maxillofacial trauma who had been admitted to the emergency department of four hospitals in the Netherlands. This study compared five haemorrhagic symptoms (peri-orbital haematoma, raccoon eyes, epistaxis, subconjunctival ecchymosis, and intra-oral haematoma) between patients not-using (NUA) and using (UA) of antithrombotics, and whether these maxillofacial haemorrhagic symptoms served as predictors for maxillofacial fractures.

Out of the 1005 patients, 812 (81%) belonged to the NUA group, and 193 (19%) to the UA group. UA patients exhibited higher frequencies of peri-orbital hematoma (54% vs. 39%, p < 0.001), raccoon eyes (10% vs. 5%, p = 0.01), and subconjunctival ecchymoses (16% vs. 7%, p < 0.001). In NUA, peri-orbital hematoma (OR = 2.5, p < 0.001), epistaxis (OR = 4.1, p < 0.001), subconjunctival ecchymosis (OR = 2.3, p = 0.02), and intra-oral hematoma (OR = 7.1, p < 0.001) were significant fracture predictors. Among UA, peri-orbital hematoma (OR = 2.2, p = 0.04), epistaxis (OR = 5.4, p < 0.001), subconjunctival ecchymosis (OR = 3.7, p = 0.008), and intra-oral hematoma (OR = 22.0, p < 0.001) were significant fracture predictors.

Maxillofacial haemorrhagic symptoms were observed more frequently in the UA group than in the NUA group. However, in both groups, maxillofacial haemorrhagic symptoms appear to be predictors of maxillofacial fractures. Caution is warranted in attributing these symptoms solely to antithrombotic use during emergency department assessments.

The online version contains supplementary material available at 10.1007/s00068-023-02428-0.