Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 May;46(3):485-493.
doi: 10.1111/coa.13717. Epub 2021 Jan 27.

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

Kristijonas Milinis  1 , Chloe Swords  2 , John C Hardman  3 , Anna Slovick  4 , Kristian Hutson  2 , Isla Kuhn  5 , Matthew E Smith  2 ; INTEGRATE (The UK ENT Trainee Research Network)
Affiliations
Meta-Analysis

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

Kristijonas Milinis et al. Clin Otolaryngol. 2021 May.

Abstract

Introduction: Nasal packing is the mainstay of epistaxis management; however, packs cause patient discomfort and can lead to hospital admission. Absorbable haemostats provide clotting factors or act as a substrate to stimulate clotting and represent a potential treatment alternative. A systematic review was performed to evaluate the efficacy of topical haemostats in the management of epistaxis.

Methods: A systematic literature search of 7 databases was performed. Only eligible randomised controlled trials (RCTs) and observational studies were included. The primary outcome was short-term haemostatic success (<7 days). Secondary outcomes included long-term haemostatic control (no rebleeding 7-30 days), patient discomfort and adverse effects. Meta-analysis was performed where possible.

Results: Of 2249 records identified, 12 were included in the qualitative synthesis and 4 RCTs were included in meta-analysis. The following haemostats were reported: gelatin-thrombin matrix (n = 8), aerosolised/gel tranexamic acid (n = 1), cellulose agents (n = 2) and fibrin sealants (n = 1). Studies involving tranexamic acid on removable delivery devices (eg, pledgets) were excluded. There was heterogeneity in outcome measures and inclusion criteria (coagulopathies/anticoagulants were excluded in 3 RCTs and 2 observational studies). The short-term haemostatic success varied between studies (13.9% to 100%). No significant post-procedural complications were reported. The meta-analysis favoured absorbable haemostatic agent versus packing (risk ratio 1.20; 95% confidence interval 1.05 to 1.37; P = .007). The risk of bias across all studies was moderate to high.

Conclusions: The evidence suggests haemostatic agents are effective at managing acute epistaxis when compared with nasal packing. More data are required before recommendations can be made regarding management in patients on anticoagulants.

Keywords: dissolvable nasal packs; epistaxis; non-absorbable nasal packs.

PubMed Disclaimer

References

REFERENCES

    1. INTEGRATE (The National ENT Trainee Research Network). Epistaxis 2016: national audit of management. J Laryngol Otol. 2017;131:1131-1141. https://doi.org/10.1017/S002221511700202X
    1. INTEGRATE (National ENT Trainee Research Network). The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. 2017;131:1142-1156. https://doi.org/10.1017/S0022215117002018
    1. INTEGRATE (National ENT Trainee Research Network). Nasal packs for epistaxis: predictors of success. Clin Otolaryngol. 2020;45(5):659-666. https://doi.org/10.1111/coa.13555
    1. Regli A, Von Ungern-Sternberg BS, Strobel WM, Pargger H, Welge-Luessen A, Reber A. The impact of postoperative nasal packing on sleep-disordered breathing and nocturnal oxygen saturation in patients with obstructive sleep apnea syndrome. Anesth Analg. 2006;102(2):615-620. https://doi.org/10.1213/01.ane.0000184814.57285.5b
    1. Nikolaou G, Holzmann D, Soyka MB. Discomfort and costs in epistaxis treatment. Eur Arch Oto-Rhino-Laryngology. 2013;270:2239-2244.

LinkOut - more resources