Management for Epistaxis in Children with Bleeding Disorders

Abstract

Objective: Medical management of epistaxis is the traditional standard of care in treating children with bleeding disorders. Our objective is to review our experience with physical intervention as a method of epistaxis management and to evaluate its safety and efficacy as an appropriate treatment for pediatric patients with an identified coagulopathy.

Method: Children with a known coagulopathy and who were treated for epistaxis were identified, and a retrospective chart review was performed. Medical records from 2000 to 2011 were reviewed and abstracted. The number of episodes, method of management used, type of coagulopathy, complications, and success rates for controlling the hemorrhage were recorded.

Results: Thirty-five children with a total of 102 encounters for epistaxis met the study criteria. Sixty-nine procedures (approximately 67.6%) did not require further surgical intervention during the intervention success period (21-28 days after the initial procedure). Physical intervention was successful 57% of the time (21 out of 37 procedures) in patients with Glanzmann thrombasthenia. In children with von Willebrand disease, physical intervention prevented recurrent epistaxis 75% of the time (21 out of 28 successful procedures). For patients with acquired coagulopathies due to chemotherapy treatment for hematogenous malignancies, physical intervention proved successful in 76% of procedures (13 of 17).

Conclusion: Medical management is the traditional treatment for epistaxis in children with known coagulopathies. In treating children with known coagulopathies where medical management is unsuccessful, physical intervention is a safe, effective, and minimally invasive treatment that may decrease the frequency of recurrences for epistaxis in children with coagulopathy.