{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T10:54:10Z","timestamp":1761648850477,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T00:00:00Z","timestamp":1611705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010term haemostatic success (&lt;7\u00a0days). Secondary outcomes included long\u2010term haemostatic control (no rebleeding 7\u201030\u00a0days), patient discomfort and adverse effects. Meta\u2010analysis was performed where possible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2249 records identified, 12 were included in the qualitative synthesis and 4 RCTs were included in meta\u2010analysis. The following haemostats were reported: gelatin\u2010thrombin matrix (n\u00a0=\u00a08), aerosolised\/gel tranexamic acid (n\u00a0=\u00a01), cellulose agents (n\u00a0=\u00a02) and fibrin sealants (n\u00a0=\u00a01). 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\u2010term haemostatic success varied between studies (13.9% to 100%). No significant post\u2010procedural complications were reported. The meta\u2010analysis favoured absorbable haemostatic agent versus packing (risk ratio 1.20; 95% confidence interval 1.05 to 1.37; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.007). The risk of bias across all studies was moderate to high.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13717","type":"journal-article","created":{"date-parts":[[2021,1,16]],"date-time":"2021-01-16T21:39:19Z","timestamp":1610833159000},"page":"485-493","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Dissolvable intranasal haemostatic agents for acute epistaxis: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1311-0335","authenticated-orcid":false,"given":"Kristijonas","family":"Milinis","sequence":"first","affiliation":[{"name":"Liverpool Head and Neck Centre Aintree University Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0431-4491","authenticated-orcid":false,"given":"Chloe","family":"Swords","sequence":"additional","affiliation":[{"name":"Ear, Nose and Throat Department Addenbrooke's Hospital Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6591-5119","authenticated-orcid":false,"given":"John C.","family":"Hardman","sequence":"additional","affiliation":[{"name":"Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Slovick","sequence":"additional","affiliation":[{"name":"Ear, Nose and Throat Department Barts Health NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristian","family":"Hutson","sequence":"additional","affiliation":[{"name":"Ear, Nose and Throat Department Addenbrooke's Hospital Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isla","family":"Kuhn","sequence":"additional","affiliation":[{"name":"School of Medicine University of Cambridge Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Ear, Nose and Throat Department Addenbrooke's Hospital Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"INTEGRATE (The UK ENT Trainee Research Network)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,1,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S002221511700202X"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215117002018"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13555"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000184814.57285.5b"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-012-2339-2"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0807078"},{"key":"e_1_2_10_8_1","unstructured":"DaviesE HopkinsC HarriesP WalkerA HewardE.COVID\u201019 epistaxis management. ENT UK.2020:1."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2017-110853"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0224"},{"key":"e_1_2_10_11_1","first-page":"88","article-title":"Fibrin glue treatment for epistaxis","volume":"40","author":"Vaiman M","year":"2002","journal-title":"Rhinology"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215115000663"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24240"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-016-3948-y"},{"key":"e_1_2_10_15_1","first-page":"304","article-title":"FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial","volume":"39","author":"C\u00f4t\u00e9 D","year":"2010","journal-title":"J Otolaryngol \u2010 Head Neck Surg"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200206000-00036"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.25000\/acem.489634","article-title":"Comparing efficacy of Surgicel \u00ae application with nasal packing in epistaxis","volume":"4","author":"S\u00f6zen T","year":"2019","journal-title":"Arch Clin Exp Med"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130408300913"},{"key":"e_1_2_10_19_1","first-page":"304","article-title":"FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial","volume":"39","author":"C\u00f4t\u00e9 D","year":"2010","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.03.030"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-017-0248-5"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000160528.50017.3C"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000160528.50017.3C"},{"key":"e_1_2_10_24_1","unstructured":"Baxter.FLOSEAL Hemostatic Matrixn.d."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59980300460-1"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27081"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.13717","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.13717","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.13717","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T19:59:54Z","timestamp":1692820794000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.13717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,27]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1111\/coa.13717"],"URL":"https:\/\/doi.org\/10.1111\/coa.13717","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"type":"print","value":"1749-4478"},{"type":"electronic","value":"1749-4486"}],"subject":[],"published":{"date-parts":[[2021,1,27]]},"assertion":[{"value":"2020-07-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}