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Prof. Ibrahim Mohamed EL Saiad Rageh :: Publications:

Combined Vitamin K Thearapy And Anti-parasitic Treatment could Improve The Outcome Of Specific Treatment Of Recurrent Epistaxis In Children : An Observation Study .
Authors: Kassem M.Kassem, Abou-Bakr E. Ras, Ibrahiem Rageh, Yahia Hamed
Year: 2009
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Local/International: Local
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Objectives : Tllis 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 severihJ ofrecurrent epistaxis in children. Patients & Methods: The study included 200 children; 115 males and 85 females with meal1 age of 8.6±2.5 years. Only 79 patients, 24 patients with severe attacks and 55 patients free of local causes were en roiled ill tlte study and 10 children of cross-matched age and sex as control group. All enrolled patients underwent filII histonJ taking with special regards to the frequency ofrecurrent attacks, its severity, provided lilies oftreatment and its effect. All enrolled patients gave blood samples for estimation of prothrombin time (PT), Intematiollal 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 pafie/lts were prescribed broad spectrum antiparasitic therapy, Group B patients received vitamin Killjectiolls ollce dail,l/.fc1r 3 daysjweek for 3 months. Group C patients were prescribed combined antiparasitic t//I.!ra11Y a/lt! vitalllill 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 frequenClJ and severihJ 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 willi sigl1ificallt difference ill favor of group B. Mean post-treatment levels of PT and INR showed significant reductioll 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, vitamin K treatment significantly reduced serum DCP in groups Band C compared to group A with non-significantly 10Uier DCP levels in group C compared to group B. Post-treatment serum DCP levels were significantly lower compared to pre-treatment levels. There was t1 positive significant correlation between reCllrrelices ofepistaxis and both PT and INR and serum DCP levels estimated at end of follow-up post-treatment. Using ROC curve analysis, i judged by area under curve, defined serum DCP as a highly specific predictor witll AUC=0.808, foUcrwed by I both PT (AUC=O.688) and INR (AUC=O.680). I • Conclusion : Idiopathic recurrent epistaxis could be attributed to hepatic impairment witli deficiellt prothrombin synthesis and the use of combined vitamin K injech'ons Wit/I broad spectrlllll allti-parasitic treatment could significantly reduce both the frequenClJ and severihJ ofrecurrent attacks ill children.

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