Management of epistaxis in patients with ventricular assist device: a retrospective review - PubMed (original) (raw)

Management of epistaxis in patients with ventricular assist device: a retrospective review

Clifford Scott Brown et al. J Otolaryngol Head Neck Surg. 2018.

Abstract

Background: Patients with a ventricular assist device (VAD) are at risk for epistaxis due to the need for anticoagulation. Additionally, these patients develop acquired von Willebrand syndrome (AvWS) due to these devices. Management is complicated by the risk of thrombosis if anticoagulation is reversed. This study sought to characterize the clinical features and management of epistaxis in this high-risk population.

Methods: Retrospective review of adults with VAD and epistaxis necessitating inpatient consultation with the otolaryngology service were included.

Results: 49 patients met inclusion criteria. All patients had a presumed diagnosis of AvWS. An elevated INR (> 2.0) was present in 18 patients (36.7%). Anticoagulation was held in 14 (28.6%) patients, though active correction was not necessary. Multiple encounters were required in 16 (32.7%) patients. Spontaneous epistaxis was associated with multiple encounters (p = 0.02). The use of hemostatic material was associated with a lower likelihood of bleeding recurrence (p = 0.05), whereas cauterization with silver nitrate alone was associated with a higher likelihood of re-intervention (p = 0.05). Surgery or embolization was not required urgently for any patient. Endoscopy under general anesthesia was performed for one patient electively. Mean follow up time was 16.6 months (σ = 6.3). At six months, 18 (36.7%) patients were deceased.

Conclusion: While these patients are at risk for recurrent spontaneous epistaxis, nonsurgical treatment without active correction of INR or AvWS was largely successful. Placement of hemostatic material, as opposed to cautery with silver nitrate, should be considered as a first-line treatment in this group. Multidisciplinary collaboration is critical for successful management.

Keywords: Anticoagulation; Epistaxis; Ventricular assist device; von Willebrand syndrome.

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Conflict of interest statement

This study was approved by the Institutional Review Board at Duke University (Pro00071269).

not applicable.

The authors declare that they have no competing interests.

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Figures

Fig. 1

Fig. 1

Bleeding Location: Distribution of bleeding locations by number and percentage. Note that sites are not mutually exclusive

Fig. 2

Fig. 2

Summary of Interventions: Distribution of interventions performed by number and percentage. Note that interventions are not mutually exclusive

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