Chitosan Packing for Epistaxis in Coagulopathy Set‐up

Abstract

Objective: The management of refractory epistaxis in the context of coagulation disorders can be challenging for the physician and agonizing for the patient. This study investigates the efficacy of chitosan, a hemostatic polysaccharide that forms a coherent seal when it comes in contact with red blood cells, on these difficult-to-treat cases. Method: The study population comprised 35 patients with bleeding diathesis (warfarin administration in 10 cases, antiplatelets in 18, both anticoagulants in 6, thrombocytopenia in 1) and persistent epistaxis despite aggressive tamponade. Treatment consisted of outpatient placement of a light packing with chitosan dressing supported by a polyvinyl acetal sponge for 48 hours. Results: Immediate control of epistaxis was successfully achieved on an outpatient basis in 32 patients (91%) within a mean time of 3.5 minutes. Three patients (9%) continued to bleed despite the chitosan pack and required further treatment (two had repacking and one had electro-coagulation of the spheno-palatine artery). Upon packing removal, mild selflimited sero-sanguinous oozing was noted in 17 cases (48%). On the 1-week follow-up, no rebleeding was reported. Conclusion: Chitosan-based nasal packing is an effective outpatient method for the management of refractory epistaxis in the setting of coagulopathy due to its unique hemostatic properties, which are independent of clotting factors and/or platelets.