Dissolvable intranasal haemostatic agents for acute epistaxis: A systematic review and meta‐analysis

Milinis, Kristijonas; Swords, Chloe; Hardman, John; Slovick, Anna; Hutson, Kristian; Kuhn, Isla; Smith, Matthew; Integrate,

doi:10.1111/coa.13717

Cited by 6 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…found no difference in epistaxis recurrence with the placement of non‐dissolvable packing for 3, 4 or 5 days, with haemostasis achieving in 85% of patients 21 . Nasal packing with products containing dissolvable haemostatic agents may offer additional options in both acute epistaxis management and on discharge 22 . The American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) do suggest that patients at risk of bleeding may benefit from the use of dissolvable packing when compared to products like Merocele or Rapid Rhino 2 .…”

Section: Discussionmentioning

confidence: 96%

“…21 Nasal packing with products containing dissolvable haemostatic agents may offer additional options in both acute epistaxis management and on discharge. 22 The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) do suggest that patients at risk of bleeding may benefit from the use of dissolvable packing when compared to products like Merocele or Rapid Rhino. 2 However, there is little data regarding their efficacy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors and management outcomes in epistaxis: a tertiary centre experience

Hughes

Teh

Hart

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background 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. Methods This is a retrospective cross‐sectional 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. Results A total of 543 patients with epistaxis (54.2% male, mean age 74.4 ± 15.7 years) 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 (P < 0.05), while the use of rivaroxaban was inversely associated severity (P = 0.002). Only HHT, haematological malignancy and CLD remained significant in multivariate models. Cautery as first‐line management was infrequently utilized while anticoagulation was frequently withheld. A longer length of stay (1.1 days vs. 4.3 days; P < 0.001) and higher 2‐week readmission rates (2.2% vs. 12.5%; P < 0.001) were noted with severe epistaxis compared with mild presentations. Conclusion Epistaxis severity is associated with certain clinical conditions and poor outcomes. Despite recommended guidelines, variations in first‐line management were evident.

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Risk factors and management outcomes in epistaxis: a tertiary centre experience

Hughes

Teh

Hart

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…A large meta-analysis revealed it to be preferable to non-dissolvable nasal packs such as RapidRhino® in terms of achieving short-term haemostatic control. 16 One randomised, controlled trial additionally found that patients may be less likely to re-present with FloSeal compared to nasal packs. 17 Particularly on a local level, many centres have been reluctant to use haemostatic agents as first-line treatment because of their initial higher cost, but subsequent cost analyses have revealed it to be a more cost-effective option compared to nasal packing for anterior epistaxis.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019: changing the future of emergency epistaxis management

et al. 2021

View full text Add to dashboard Cite

Background Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. Methods A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. Results A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. Conclusion The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens.

show abstract