Management of Persistent Epistaxis Using Floseal Hemostatic Matrix vs. traditional nasal packing: a prospective randomized control trial (original) (raw)
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FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial
Journal of Otolaryngology Head Neck Surgery Le Journal D Oto Rhino Laryngologie Et De Chirurgie Cervico Faciale, 2010
Objective: Although most cases of epistaxis are managed conservatively, occasionally they can progress to significant hemorrhage requiring more involved management or surgery. Endoscopic ligation surgery is the current institutional standard of care for patients who fail conservative management. However, surgical ligation requires availability of surgical resources and patients who are able to withstand an anesthetic. This study's objective was to determine the efficacy of FloSeal hemostatic matrix (Baxter Healthcare Corporation, Hayward, CA) in epistaxis refractory to nasal packing. Methods: A prospective clinical trial was conducted on epistaxis patients whose nasal hemorrhage persisted despite adequate nasal packing by the otolaryngology-head and neck surgery team. Once enrolled, patients are given a trial of intranasal FloSeal hemostatic matrix to abort the epistaxis. Should this fail, patients then proceed with surgical clipping. Results: Our prospective cohort demonstrated significant success in 80% of patients with persistent epistaxis, who would have otherwise been taken to the operating theatre, avoiding the need for further surgical intervention. The majority of enrolled patients with persistent nasal hemorrhage were adequately managed with the hemostatic matrix alone and were discharged from hospital in a timeframe comparable to that of surgical managment. Conclusions: This study revealed a highly effective tool in the otolaryngologist's management of persistent epistaxis. Given the ease of use, decreased morbidity to the patient, and cost-effectiveness, FloSeal hemostatic matrix could change clinical practice in managing this common condition. SOMMAIRE Objectif: La plupart du temps, le traitement conservateur suffit à réprimer les épistaxis mais, parfois, les saignements é voluent vers des hé morragies suffisamment importantes pour né cessiter des interventions é nergiques ou la chirurgie. Aujourd'hui, on soumet géné ralement les cas ré fractaires au traitement conservateur à la ligature endoscopique en é tablissement. Mais, pour ce faire, il faut disposer des ressources né cessaires, et les patients doivent pouvoir supporter l'anesthésie. La présente é tude avait pour objectif de dé terminer l'efficacité du gel hé mostatique FloSeal (Baxter Healthcare Corporation, Hayward [CA]) dans les é pistaxis ré fractaires au tamponnement nasal. Mé thode: Un essai clinique prospectif a é té mené chez des patients souffrant d'é pistaxis rebelles malgré un tamponnement nasal adé quat, ré alisé au service d'otorhinolaryngologie par l'é quipe de chirurgie cervico-faciale. Une fois les patients sé lectionné s, ceux-ci recevaient, à titre expé rimental, le gel hé mostatique FloSeal par voie intranasale afin de provoquer l'arrê t de l'é pistaxis. En cas d'é chec, on procé dait alors à la pose chirurgicale d'un clip. Ré sultats: Le traitement s'est montré efficace chez 80% des patients qui souffraient d'é pistaxis rebelles dans la cohorte prospective et qui, dans le cas contraire, auraient dû ê tre opé ré s, ce qui leur a é vité une intervention chirurgicale. Le gel hé mostatique à lui seul a donné de bons ré sultats chez la plupart des participants atteints d'hé morragies nasales persistantes, et ceux-ci ont obtenu leur congé de l'hô pital dans un dé lai comparable à celui imposé par le traitement chirurgical. Conclusions: L'essai a montré que FloSeal é tait un outil trè s efficace, qui s'ajoutait à l'arsenal thé rapeutique des otorhinolaryngologistes dans le traitement des é pistaxis rebelles. Compte tenu de sa facilité d'emploi, de la diminution de la morbidité et de son bon rapport coû t-efficacité , le gel hé mostatique FloSeal pourrait changer la pratique clinique en matiè re de prise en charge de cette affection courante.
Surgical treatment of nasal packing refractory epistaxis
Brazilian Journal of Otorhinolaryngology (Impresso), 2009
Epi staxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. Aim: To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. Material and Methods: Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. Results: Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation. Conclusion: Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.
Nasal Packs for Epistaxis: Predictors of Success
Clinical Otolaryngology, 2020
ObjectivesTo investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).DesignProspective cohort study.SettingA nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period.ParticipantsPatients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs.Main outcome measuresThe primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.ResultsA cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supp...
European Annals of Otorhinolaryngology, Head and Neck Diseases, 2017
ANORL-602; No. of Pages 5 2 E. Bequignon et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2016) xxx-xxx is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.
Epistaxis management - our point of view and literature review
Romanian Journal of Rhinology, 2017
Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed. The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring int...
Ear, nose, & throat journal, 2011
We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients-43 men and 31 women (mean age: 64.4 yr)-who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at t...
BMJ Open, 2019
IntroductionPatients presenting to emergency departments (EDs) with epistaxis uncontrolled by subsequent simple first aid measures or application of topical vasoconstrictors will typically undergo anterior nasal packing. Packing is effective, but can be extremely painful and unpleasant and patients usually need hospital admission. Tranexamic acid (TXA) is a cheap, safe, readily available antifibrinolytic agent known to be beneficial in a variety of clinical settings where uncontrolled bleeding may be a problem. Anecdotal evidence suggests that topical TXA may be of value in persistent epistaxis; however, further evaluation is required.Methods and analysisThis is a multicentre, double-blind, parallel group, randomised, controlled trial comparing the use of topical intranasal TXA with indistinguishable placebo in adults presenting to UK EDs with persistent atraumatic epistaxis. Follow-up is at 1 week by structured telephone review. The primary outcome measure is the subsequent need fo...
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Epistaxis is the most common emergency in otorhinolaryngology. The usual treatment in most cases of anterior epistaxis and almost all cases of posterior epistaxis is nasal packing followed by either cauterization, embolization or ligation. This study has been undertaken to evaluate the use of nasal endoscopic cauterization as the first line treatment both in anterior as well as posterior epistaxis. MATERIALS AND METHODS The study consisted of total 36 patients, who presented with epistaxis. All patients were first managed with nasal endoscopy and endoscopic electrocautery. Only the patients in which bleeding point could not be located by initial endoscopy were managed by insertion of nasal packing. The discomforts and minor complications in patients undergoing successful endoscopic cauterization and in the patients who were taken for nasal packing were observed along with average stay of patient in the hospital. RESULTS Out of total 36 patients, 28 patients (78%) could be successfully managed directly by endoscopic cauterization without undergoing nasal packing and the obvious discomfort associated with it. The average length of hospital stay in the patients without nasal pack was 1.39 days while for patients who were managed by nasal packing the average length of hospital stay was around 3 days. The patients who underwent nasal packing, 5 (62%) had minor complications. While in patients with endoscopic treatment as first line management, no such complications were observed. CONCLUSION Along with a good success rate, endoscopic cauterization is very effective in reducing the nasal packing related complications and the duration of stay of patient in the hospital, thus reducing the cost of treatment as well. This makes endoscopic cauterization a better first line management for both anterior as well as posterior epistaxis.
The Journal of Otolaryngology, 2004
Objective: This prospective randomized trial was designed to compare intranasal endoscopic sphenopalatine artery ligation (ESAL) with conventional nasal packing in the treatment of recurrent epistaxis. Methods: Patients were registered in the study databank following referral for epistaxis control to the otolaryngology service at the University of Alberta. All patients were initially packed using Merocel (Xomed Surgical Products, Jacksonville, FL) nasal dressings bilaterally. Patients were enrolled in the study following failure of Merocel packings. Informed consent was obtained in accordance with the Health Research Ethics Board. The patients were then managed with Vaseline nasal packs or ESAL. Patient demographics, treatment characteristics, number of hospitalization days, and rates of recurrence were recorded prospectively. The total cost of treatment for each patient was calculated.