Domiciliary floseal prevents admission for epistaxis in hereditary hemorrhagic telangiectasia.

INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant bleeding disorder characterized by arteriovenous malformations and multiple telangiectasia affecting the skin, abdominal viscera, and mucosa. It affects approximately one in 5,000 to 8,000 people and presents with severe recurrent epistaxis, gastrointestinal bleeding, and anemia. Recurrent epistaxis, caused by friable telangiectasia affecting the nasal mucosa, is the most common symptom, affecting approximately 93% of patients with HHT. The episodes of epistaxis experienced may be selflimiting in nature; however, up to one-third of patients with HHT experience severe bleeds requiring frequent hospital admissions for nasal packing or surgical control. This creates a significant cost burden to the UK National Health Service (NHS) and has a negative impact on patients’ quality of life. Numerous medical and surgical therapies have previously been described in the management of epistaxis in HHT; however, admission for nasal packing or surgical and interventional radiological procedures remains a frequent event in these patients. FloSeal (Baxter Healthcare Corporation, Hayward, CA) is a novel hemostatic agent, first described as a surgical hemostat but more recently advocated for its use in epistaxis. At £176 per application, the cost of FloSeal is less than half of the cost per night of hospital stay at our institution (£409). Herein we describe the domiciliary use of FloSeal hemostatic matrix in patients with HHT, enabling patients control in managing epistaxis, thereby preventing repeated hospital admission.