Cost effectiveness of posterior epistaxis management using a gelatin-thrombin matrix or Rapid Rhino

Toppi, Jason; Chan, Sor Way; Pratap, Upasna; Kumar, Shanesh; Phan, Robert; Magarey, Matthew; Ong, Jason J.

doi:10.21037/ajo.2020.03.06

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…Nasopore has also been found to be less painful to the patient than packing with balloon tamponade devices such as Rapid Rhino, resulting in reduced rebleeding risk and therefore may offer a suitable alternative and may reduce the need for admission 23 . While no cost benefit analysis could be found for Nasopore versus Rapid Rhino, gel thrombin matrix like Floseal has been shown to offer cost‐saving alternative to Rapid Rhino 24 …”

Section: Discussionmentioning

confidence: 99%

“…23 While no cost benefit analysis could be found for Nasopore versus Rapid Rhino, gel thrombin matrix like Floseal has been shown to offer cost-saving alternative to Rapid Rhino. 24 Unfortunately, the use of various packing agents and their benefits were beyond the scope of this study. The AAO-HNS recommends the use of Nasopore in anticoagulated patients or those at higher risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

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

Hughes

Teh

Hart

et al. 2022

ANZ Journal of Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

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“…According to statistics, about 60% of people will experience a nosebleed in their lifetime ( 1 ), but only one-tenth of them will see a doctor for this reason, because in most cases it is mucosal hemorrhage. Nasal packing still represents the first-line approach to epistaxis in most emergency room, the gelatin-thrombin matrix as the better material and high cost-effectiveness of the management of posterior epistaxis than ribbon gauze or the Rapid Rhino ( 2 ) although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective than endoscopic electrocoagulation-based management of posterior epistaxis. In conclusion, cauterization should be the first-line approach for its high cost-effectiveness rate and low risk of complications.…”

Section: Introductionmentioning

confidence: 99%

Etiology and clinical characteristics of primary epistaxis

Li¹,

Luo²,

Li³

et al. 2023

Ann Transl Med

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Background Primary epistaxis (rupture of nasal artery vessels) is a common emergency, but the related factors are still controversial. This study collected the data on primary epistaxis patients and healthy people undergoing a physical examination at the same center to explore and classify primary epistaxis by its characteristics. Methods Primary epistaxis was divided into septal epistaxis and non-septal epistaxis, and logistic regression was performed to determine the risk factors. Results In total, 196 cases of septal epistaxis and 127 cases of non-septal epistaxis, and the control group was 182 healthy subjects. There were significant differences in sex, drinking history, hypertension history and hyperlipidemia between the bleeding group and the control group, but no correlation with smoking, diabetes, cardiovascular and cerebrovascular events, or anticoagulant drug use. In the age group of 26–40 years it was related to alcohol consumption and hypertension, for those aged 41–55 years it was related to hypertension, in the age group of 56–70 years it was related to hypertension, high triglyceride and high apolipoprotein B levels, and no related factors were found in the age group >70 years. The risk factors for non-septal cases were increased low-density lipoprotein (LDL) [P=0.035; odds ratio (OR), 2.450; 95% confidence interval (CI): 1.067–5.624], male sex (P=0.002; OR, 3.136; 95% CI: 1.501–6.554), and younger age (P=0.000; OR, 0.941; 95%CI: 0.920–0.962). All patients with nosebleed underwent nasal endoscopy and the bleeding site was successfully located and treated with electrocoagulation. No further bleeding or serious complications occurred after 6 months of follow-up. Conclusions Primary epistaxis is more common in males and is related to alcohol consumption, hypertension, and hyperlipidemia. In the young age groups, male sex, and increased LDL were high risk factors for non-septal hemorrhage in winter and spring. Nasal endoscopy and electrocoagulation are safe and effective.

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