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ENT Facial and Neck Surgery Stéphane Hervé

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November 19, 2018

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Frequent nosebleeds: are nasal sprays effective?

December 2, 2017

 

The effectiveness of nasal sprays to reduce the frequency and duration of nosebleeds (epistaxis) caused by Hereditary Haemorrhagic Telangiectasia (HHT) was the subject of a study conducted in France.

 

HHT, or Rendu-Osler disease, is a genetic disease consisting of a deregulation of vessel formation that leads to arteriovenous dilatation. This results in vascular malformations such as telangiectasia (small dilated vessels) and angiomas (clusters of blood vessel) throughout the body, but mainly on the face and the ends of limbs.

 

Epistaxis is the most common and impairing manifestation of this disease. There is currently no medical or surgical treatment available to heal from these haemorrhages definitely. Dr. Sophie Dupuis-Girod and her colleagues evaluated the efficacy of 3 different doses of Avastin nasal spray, repeatedly administered for a month. Avastin contains a monoclonal antibody that slows the growth of new blood vessels. 

 

Researchers observed that the average monthly epistaxis duration measured at 3 months was not significantly different in patients receiving Avastin in comparison with the placebo group. Toxicity was low and no severe adverse effects were reported. Treatment with Avastin had no measurable effect on secondary outcomes, including the number of epistaxis episodes, quality of life, number of red blood cells transfusions, or haemoglobin and ferritin levels.

 

Therefore, it is necessary to continue treating epistaxis one at a time, generally by using laser.

 

Article: Effect of Bevacizumab Nasal Spray on Epistaxis Duration in Hereditary Hemorrhagic Telangectasia: A Randomized Clinical Trial

Dupuis-Girod S et al. JAMA. 2016 Sep 6;316(9):934-42. doi: 10.1001/jama.2016.11387.

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