Combined Vitamin K Therapy And Anti-parasitic Treatment Could Improve The Outcome Of Specific Treatment Of Recurrent Epistaxis In Children : An Observational Study
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Objectives : This study was designed to explore the correlation between recurrent epistaxis and parasitic infestations and disturbed hemostatic profile and to evaluate the impact of antiparasitic therapy on the frequency and severity of recurrent epistaxis in children. Patients & Methods : The study included 200 children; 115 males and 85 females with mean age of 8.6±2.5 years. Only 79 patients, 24 patients with severe attacks and 55 patients free of local causes were enrolled in the study and 10 children of cross-matched age and sex as control group. All enrolled patients underwent full history taking with special regards to the frequency of recurrent attacks, its severity, provided lines of treatment and its effect. All enrolled patients gave blood samples for estimation of prothrombin time (PT), International Normalized Ratio (INR) and ELYSA estimation of serum levels of Des-y-carboxyprothrombin (DCP). Stool analysis was conducted for determination of parasitic infestation. All patients received the appropriate treatment for the attack of epistaxis and were randomly allocated into 3 groups: Group A patients were prescribed broad spectrum antiparasitic therapy, Group B patients received vitamin K injections once daily for 3 days/week for 3 months. Group C patients were prescribed combined antiparasitic therapy and vitamin K injections. Results : At the time of presentation, no active intervention to arrest bleeding except pinching, observation, systemic nasal decongestants and antibiotics was effective in 119 patients, nasal packing was effective in 35 patients, while 46 patients required cauterization. Applied lines of treatment significantly controlled both the frequency and severity of recurrent attacks of epistaxis with significant difference compared to pre-treatment figures. Combined therapy provided significant reduction of both frequency and severity of recurrent attacks compared both to those received vitamin K only or anti-parasitic treatment only with significant difference iii favor of group B. Mean post-treatment levels of PT and INR showed significant reduction compared to pretreatment levels with significant difference between groups C and group A. Serum DCP levels estimated either pre- or post-treatment were significantly higher compared to control levels, however, vitaniin K treatment significantly reduced serum DCP in groups B and C compared to group A with non-significantly lower DCP levels in group C compared to group B. Post-treatment serum DCP levels were significantly lower compared to pre-treatment levels. There was a positive significant correlation between recurrences of epistaxis and both PT and INR and serum DCP levels estimated at end of follow-up post-treatment. Using ROC curve analysis, judged by area under curve, defined serum DCP as a highly specific predictor with A UC=0.808, followed by both PT (AUC=0.688) and INR (AUC=0.680).