Yuan-Pin Hsu1,2,3, Chin-Wang Hsu1,3, Chyi-Huey Bai4, Sheng-Wei Cheng2,5, Chiehfeng Chen2,4,6,7,8. 1. 1 Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 2. 2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 3. 3 Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 4. 4 Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 5. 5 Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 6. 6 Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. 7. 7 Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 8. 8 Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Abstract
OBJECTIVES: The aim of this study (PROSPERO ID: CRD42017081952) was to evaluate medical treatment for epistaxis from hereditary hemorrhagic telangiectasia (HHT). DATA SOURCES: PubMed, Embase, Scopus, and Cochrane Library databases were interrogated from their inceptions to November 2017. REVIEW METHODS: Randomized clinical trials comparing medical treatment with placebo for epistaxis of HHT were included. We used a random-effects model to synthesize overall effects. Heterogeneity was evaluated with the I2 statistic. RESULTS: Eight studies were identified after systematic searching. The use of bevacizumab (BV), tranexamic acid, and estrogen, regardless of the route of administration, had no significant influence on frequency of episodes. Tamoxifen was superior to placebo in both frequency and severity of epistaxis. For duration of epistaxis, nasal spray BV, oral or nasal spray tranexamic acid, and nasal spray estrogen had no significant differences versus placebo, but patients receiving submucosal BV showed lower duration of epistaxis (mean difference: -219.00 min/mo, 95% CI: -271.90 to -166.10). Medical treatment for HHT had no significant changes of mean hemoglobin concentration (pooled mean difference: -0.23 mg/dL, 95% CI: -0.65 to 0.20, I2 = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: -0.16 to 0.30, I2 = 0%). CONCLUSIONS: Only limited evidence provides a benefit on frequency of epistaxis by treatment with tamoxifen and duration of epistaxis by treatment with submucosal BV among patients with HHT. Mean hemoglobin concentration and quality of life were not influenced by medical treatment.
OBJECTIVES: The aim of this study (PROSPERO ID: CRD42017081952) was to evaluate medical treatment for epistaxis from hereditary hemorrhagic telangiectasia (HHT). DATA SOURCES: PubMed, Embase, Scopus, and Cochrane Library databases were interrogated from their inceptions to November 2017. REVIEW METHODS: Randomized clinical trials comparing medical treatment with placebo for epistaxis of HHT were included. We used a random-effects model to synthesize overall effects. Heterogeneity was evaluated with the I2 statistic. RESULTS: Eight studies were identified after systematic searching. The use of bevacizumab (BV), tranexamic acid, and estrogen, regardless of the route of administration, had no significant influence on frequency of episodes. Tamoxifen was superior to placebo in both frequency and severity of epistaxis. For duration of epistaxis, nasal spray BV, oral or nasal spray tranexamic acid, and nasal spray estrogen had no significant differences versus placebo, but patients receiving submucosal BV showed lower duration of epistaxis (mean difference: -219.00 min/mo, 95% CI: -271.90 to -166.10). Medical treatment for HHT had no significant changes of mean hemoglobin concentration (pooled mean difference: -0.23 mg/dL, 95% CI: -0.65 to 0.20, I2 = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: -0.16 to 0.30, I2 = 0%). CONCLUSIONS: Only limited evidence provides a benefit on frequency of epistaxis by treatment with tamoxifen and duration of epistaxis by treatment with submucosal BV among patients with HHT. Mean hemoglobin concentration and quality of life were not influenced by medical treatment.
Authors: Cilgia Dür; L Anschuetz; S Negoias; O C Bulut; A Angelillo-Scherrer; M Caversaccio Journal: Eur Arch Otorhinolaryngol Date: 2021-03-04 Impact factor: 2.503
Authors: Hanny Al-Samkari; Raj S Kasthuri; Joseph G Parambil; Hasan A Albitar; Yahya A Almodallal; Carolina Vázquez; Marcelo M Serra; Sophie Dupuis-Girod; Craig B Wilsen; Justin P McWilliams; Evan H Fountain; James R Gossage; Clifford R Weiss; Muhammad A Latif; Assaf Issachar; Meir Mei-Zahav; Mary E Meek; Miles Conrad; Josanna Rodriguez-Lopez; David J Kuter; Vivek N Iyer Journal: Haematologica Date: 2021-08-01 Impact factor: 9.941