Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report
Abstract Background Severe epistaxis is often difficult to control in patients with hereditary hemorrhagic telangiectasia (HHT). Propranolol has been shown to have antiangiogenic properties in vitro and in vivo and is commonly used to treat hemangiomas. We present our experience with topical nasal p...
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SAGE Publishing
2017-10-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s40463-017-0235-x |
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| author | Meir Mei-Zahav Hannah Blau Elchanan Bruckheimer Eyal Zur Neta Goldschmidt |
| author_facet | Meir Mei-Zahav Hannah Blau Elchanan Bruckheimer Eyal Zur Neta Goldschmidt |
| author_sort | Meir Mei-Zahav |
| collection | DOAJ |
| description | Abstract Background Severe epistaxis is often difficult to control in patients with hereditary hemorrhagic telangiectasia (HHT). Propranolol has been shown to have antiangiogenic properties in vitro and in vivo and is commonly used to treat hemangiomas. We present our experience with topical nasal propranolol for the treatment of moderate to severe epistaxis in patients with HHT. Methods Retrospective case series. Six patients with HHT were treated with 0.5 cm3 of 1.5% propranolol gel, applied to each nostril twice daily for at least 12 weeks. Outcome measures were epistaxis severity score (ESS), hemoglobin level, and number of blood transfusions prior to and while on treatment. Local and systemic side effects were recorded. Results The mean duration of treatment was 30 ± 5.6 weeks. A significant improvement in the ESS was found in all patients, with a mean decrease from 6.4 ± 2.1 at treatment onset to 3.5 ± 1.7 at 12 weeks (p = 0.028). Hemoglobin level increased significantly from 8.4 ± 3.1 to 11.0 ± 1.8 g/dL at 12 weeks (p = 0.043). The mean number of blood transfusions decreased from 4.5 ± 4.9 before treatment to 2.5 ± 2.9 at 12 weeks and 0.3 ± 0.8 at 24 weeks, but the difference did not reach statistical significance (p = 0.109 for both). No significant side effects of treatment were recorded. Conclusions These preliminary results suggest that topical propranolol may be effective for the treatment of epistaxis in patients with HHT. A prospective controlled trial is required to confirm our findings. |
| format | Article |
| id | doaj-art-df8d19e4b6ea4f13bc9625ca1793da71 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2017-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-df8d19e4b6ea4f13bc9625ca1793da712025-01-03T01:45:48ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162017-10-014611410.1186/s40463-017-0235-xTopical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary reportMeir Mei-Zahav0Hannah Blau1Elchanan Bruckheimer2Eyal Zur3Neta Goldschmidt4The National HHT Center, Pulmonary Institute, Schneider Children’s Medical Center of IsraelThe National HHT Center, Pulmonary Institute, Schneider Children’s Medical Center of IsraelCardiology Institutes, Schneider Children’s Medical Center of IsraelSuper-Pharm Professional - Central Compounding PharmacyDepartment of Hematology, Hadassah-Hebrew University Medical CenterAbstract Background Severe epistaxis is often difficult to control in patients with hereditary hemorrhagic telangiectasia (HHT). Propranolol has been shown to have antiangiogenic properties in vitro and in vivo and is commonly used to treat hemangiomas. We present our experience with topical nasal propranolol for the treatment of moderate to severe epistaxis in patients with HHT. Methods Retrospective case series. Six patients with HHT were treated with 0.5 cm3 of 1.5% propranolol gel, applied to each nostril twice daily for at least 12 weeks. Outcome measures were epistaxis severity score (ESS), hemoglobin level, and number of blood transfusions prior to and while on treatment. Local and systemic side effects were recorded. Results The mean duration of treatment was 30 ± 5.6 weeks. A significant improvement in the ESS was found in all patients, with a mean decrease from 6.4 ± 2.1 at treatment onset to 3.5 ± 1.7 at 12 weeks (p = 0.028). Hemoglobin level increased significantly from 8.4 ± 3.1 to 11.0 ± 1.8 g/dL at 12 weeks (p = 0.043). The mean number of blood transfusions decreased from 4.5 ± 4.9 before treatment to 2.5 ± 2.9 at 12 weeks and 0.3 ± 0.8 at 24 weeks, but the difference did not reach statistical significance (p = 0.109 for both). No significant side effects of treatment were recorded. Conclusions These preliminary results suggest that topical propranolol may be effective for the treatment of epistaxis in patients with HHT. A prospective controlled trial is required to confirm our findings.http://link.springer.com/article/10.1186/s40463-017-0235-xHereditary hemorrhagic telangiectasiaEpistaxisPropranololAnti-angiogenesis |
| spellingShingle | Meir Mei-Zahav Hannah Blau Elchanan Bruckheimer Eyal Zur Neta Goldschmidt Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report Journal of Otolaryngology - Head and Neck Surgery Hereditary hemorrhagic telangiectasia Epistaxis Propranolol Anti-angiogenesis |
| title | Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report |
| title_full | Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report |
| title_fullStr | Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report |
| title_full_unstemmed | Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report |
| title_short | Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report |
| title_sort | topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia a preliminary report |
| topic | Hereditary hemorrhagic telangiectasia Epistaxis Propranolol Anti-angiogenesis |
| url | http://link.springer.com/article/10.1186/s40463-017-0235-x |
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