Floseal in the treatment of epistaxis

Topic Status Complete

Floseal is a bioresorbable topical haemostatic agent which can be used in the treatment of epistaxis (nosebleeds) if first aid treatments do not work.

Outcome of the appraisal

 

The evidence supports the routine adoption of Floseal gelatine-thrombin haemostatic matrix as a treatment option in people with acute epistaxis.
The available evidence suggests that Floseal is as effective as nasal packing with non-dissolvable material at stopping bleeding for up to 14 days and may reduce the rate of overall re-bleeding. Floseal is associated with reduced pain and better patient satisfaction during treatment than conventional nasal packing.
Although Floseal for the treatment of acute epistaxis is cost-incurring, with a cost of £271 per re-bleed prevented, it is considered to be a plausibly cost-effective intervention.
Health Technology Wales recommends the acquisition of evidence on the effectiveness of gelatine-thrombin haemostatic matrices for children with acute epistaxis.

Why was this topic appraised?

 

Epistaxis, also known as nosebleed, is a very common condition caused by bleeding from the blood vessels inside the nostrils. Most of the UK population experience epistaxis at some point but only a small proportion require medical treatment. Epistaxis that does not resolve with conservative treatment within 10 to 15 minutes requires emergency treatment. This is usually undertaken in a hospital emergency department through the use of nasal cautery or packing the nostrils with non-dissolvable material.
Haemostatic matrices made from gelatine and thrombin are a type of local intervention applied directly inside the nose to control bleeding. They are a type of dissolvable nasal packing that also stimulates local blood clotting. The claimed advantages over conventional nasal packing are that there is no need for removal, that the treatment causes less discomfort for patients and that there is usually no need for hospital admission. These claimed benefits could reduce costs due to less hospital time and resources being required.

Plain language summary

 

Nosebleeds occur when blood vessels in the lining of the nose burst. The medical term for a nosebleed is “epistaxis”. There are many reasons why nosebleeds may happen, such as infection, injury, allergic reaction, nose picking and others. Most nosebleeds resolve with first-aid at home. Epistaxis that does not resolve with treatment after 10 to 15 minutes requires emergency treatment at hospital. This can involve nasal “packing” or cauterization. Nasal packing can be uncomfortable, usually requires admission to hospital for observation and requires removal by a clinician that can sometimes cause re-bleeding.

Floseal is a brand of nasal packing that uses ‘dissolvable’ materials. It does not require observation or removal. As such, patients won’t need to be admitted to hospital.

Health Technology Wales looked for evidence on the use of floseal to treat to treat acute epistaxis. The evidence supports the routine adoption of Floseal gelatine-thrombin haemostatic matrix as a treatment option in people with acute epistaxis.

 

Topic Exploration Report

TER470 09.2023

Evidence Appraisal Review

EAR058 05.2024

Guidance

GUI058 05.2024

GUI

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