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 I 2 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, I 2 = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: −0.16 to 0.30, I 2 = 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.

Original languageEnglish
Pages (from-to)22-35
Number of pages14
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume160
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Hereditary Hemorrhagic Telangiectasia
Epistaxis
Meta-Analysis
Nasal Sprays
Tranexamic Acid
Placebos
Tamoxifen
Therapeutics
Oral Sprays
Estrogens
Hemoglobins
Quality of Life
Information Storage and Retrieval
PubMed
Libraries
Randomized Controlled Trials
Databases
Bevacizumab

Keywords

  • bevacizumab
  • drug
  • epistaxis
  • estrogen
  • hereditary hemorrhagic telangiectasia
  • medicine
  • tamoxifen
  • tranexamic acid

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{01b124083fa146ae83b9e1a0b18d32ec,
title = "Medical Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Meta-analysis",
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 I 2 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, I 2 = 0{\%}) or quality of life (pooled standardized mean difference: 0.07, 95{\%} CI: −0.16 to 0.30, I 2 = 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.",
keywords = "bevacizumab, drug, epistaxis, estrogen, hereditary hemorrhagic telangiectasia, medicine, tamoxifen, tranexamic acid",
author = "Hsu, {Yuan Pin} and Hsu, {Chin Wang} and Bai, {Chyi Huey} and Cheng, {Sheng Wei} and Chiehfeng Chen",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0194599818797316",
language = "English",
volume = "160",
pages = "22--35",
journal = "Otolaryngology - Head and Neck Surgery",
issn = "0194-5998",
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number = "1",

}

TY - JOUR

T1 - Medical Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia

T2 - A Meta-analysis

AU - Hsu, Yuan Pin

AU - Hsu, Chin Wang

AU - Bai, Chyi Huey

AU - Cheng, Sheng Wei

AU - Chen, Chiehfeng

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 I 2 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, I 2 = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: −0.16 to 0.30, I 2 = 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.

AB - 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 I 2 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, I 2 = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: −0.16 to 0.30, I 2 = 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.

KW - bevacizumab

KW - drug

KW - epistaxis

KW - estrogen

KW - hereditary hemorrhagic telangiectasia

KW - medicine

KW - tamoxifen

KW - tranexamic acid

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U2 - 10.1177/0194599818797316

DO - 10.1177/0194599818797316

M3 - Review article

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VL - 160

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JO - Otolaryngology - Head and Neck Surgery

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SN - 0194-5998

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