title: Fibrin glue in initial treatment of epistaxis in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease).
abstract: The purpose of the present study was to evaluate the haemostatic efficacy of fibrin sealant in patients with hereditary haemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease suffering epistaxis. A retrospective observational study of patients with HHT who were admitted to an emergency room for anterior or posterior epistaxis during May 2000-March 2003. A total of 24 patients were evaluated, of whom 15 were managed with foam nasal packing during May 2000-March 2002 and another nine were treated during March 2002-March 2003 with 0.3 ml fibrin sealant spray (Quixil; Omrix, Belgium). The immediate and the distant results were compared. Immediate haemostasis was achieved in all seven patients treated with fibrin glue, with good healing of bleeding sites, no secondary bleeding, no inflammation, and no plaque or crists. Twelve months of follow-up monitoring (until October 2003) of atrophic changes of nasal mucosa, bleeding frequency and intensity proved absence of atrophy of nasal mucosa and decreased bleeding frequency. In this group, the bleeding episode duration averaged 2 min 35 s since the moment of admittance. In the nasal packing group, we found local swelling, pain, and slow healing of the bleeding site with accidental atrophy of nasal mucosa and no effect on further bleeding frequency and intensity. Removal of nasal packing frequently initiates secondary bleeding. The rates of these side effects were higher in comparison with the fibrin glue group. The bleeding episode duration was also longer. In patients with HHT suffering profuse epistaxis, fibrin glue is more effective and convenient for the patients as compared with foam nasal packing. It is also safer, since it lacks the complications that usually accompany packing as swelling, atrophy of the nasal mucosa, and secondary bleeding provoked by the removal of the pack.
authors.affiliation: Department of Otolaryngology, Assaf Harofeh Medical Center, affiliated to the Sakler School of Medicine, Tel Aviv University, Israel and Israel National Hemophilia Center, Sheba Medical Center, Tel-Hashomer, Israel. vaimed@yahoo.com
authors.forename: Michael
authors.initials: M
authors.lastname: Vaiman
authors.forename: Uri
authors.initials: U
authors.lastname: Martinovich
authors.forename: Efraim
authors.initials: E
authors.lastname: Eviatar
authors.forename: Alex
authors.initials: A
authors.lastname: Kessler
authors.forename: Samuel
authors.initials: S
authors.lastname: Segal
mesh_terms: D000328:Adult; D004638:Emergency Treatment; D004844:Epistaxis / Q000150:complications / Q000628:therapy*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000628:therapy*
chemical_list: D015718:Fibrin Tissue Adhesive