Use of a sprayed fibrin hemostatic sealant after laser therapy for hereditary hemorrhagic telangiectasia epistaxis.
BACKGROUND
Hereditary hemorrhagic telangiectasia (HHT) is a relatively common autosomal dominant condition. Epistaxis is a frequent manifestation, often occurring daily and requiring iron and blood transfusions. Surgery often is bloody and difficult. The aim of this study was to evaluate the effectiveness of a sprayed fibrin, hemostatic sealant in preventing postoperative epistaxis after laser treatment of nasal mucosa in HHT. Fibrin sealant was compared with nasal packing for likelihood of postoperative epistaxis and financial impact including material costs and hospitalization fees.


METHODS
Retrospective review was performed of 64 individual laser treatments for epistaxis in HHT patients at the University of California, San Diego, Medical Center between 2002 and 2005. Nasal packing was used in 30 procedures and fibrin sealant was used in 34 procedures.


RESULTS
Six of 30 (20%) procedures using postoperative nasal packing required admission with an average hospital expense of $5914. One of 34 patients (3%) in the fibrin sealant group required hospitalization (p = 0.04).


CONCLUSIONS
Aerosolized fibrin sealant prevents postoperative epistaxis after nasal laser treatment in HHT patients. Compared with traditional nasal packing we found improved patient comfort and recovery with substantial cost savings.
Richmon
Jeremy D
JD
Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, USA.
Tian
Ying
Y
Husseman
Jacob
J
Davidson
Terence M
TM
D000328:Adult; D000368:Aged; D004844:Epistaxis / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000191:economics / Q000627:therapeutic use*; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000601:surgery*; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics