FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial.

OBJECTIVE

Although most cases of epistaxis are managed conservatively, occasionally they can progress to significant hemorrhage requiring more involved management or surgery. Endoscopic ligation surgery is the current institutional standard of care for patients who fail conservative management. However, surgical ligation requires availability of surgical resources and patients who are able to withstand an anesthetic. This study's objective was to determine the efficacy of FloSeal hemostatic matrix (Baxter Healthcare Corporation, Hayward, CA) in epistaxis refractory to nasal packing.

METHODS

A prospective clinical trial was conducted on epistaxis patients whose nasal hemorrhage persisted despite adequate nasal packing by the otolaryngology-head and neck surgery team. Once enrolled, patients are given a trial of intranasal FloSeal hemostatic matrix to abort the epistaxis. Should this fail, patients then proceed with surgical clipping.

RESULTS

Our prospective cohort demonstrated significant success in 80% of patients with persistent epistaxis, who would have otherwise been taken to the operating theatre, avoiding the need for further surgical intervention. The majority of enrolled patients with persistent nasal hemorrhage were adequately managed with the hemostatic matrix alone and were discharged from hospital in a timeframe comparable to that of surgical managment.

CONCLUSIONS

This study revealed a highly effective tool in the otolaryngologist's management of persistent epistaxis. Given the ease of use, decreased morbidity to the patient, and cost-effectiveness, FloSeal hemostatic matrix could change clinical practice in managing this common condition.