Download Presentation. - Thomas S. Higgins, MD, MSPH

Safety of in-office balloon sinus dilation with concurrent
antiplatelet and anticoagulant therapy
1,2
Detherage ;
1,2
MSPH
Jillian
Thomas S. Higgins, MD,
1University of Louisville, 2Kentuckiana Ear, Nose & Throat, PSC
Abstract
Methods and Materials
Results
INTRODUCTION: Due to the high risk of bleeding in patients taking antiplatelets and
anticoagulants, it is usually recommended that patients discontinue these medications around
the time of endoscopic sinus surgery. Balloon sinus dilation is a tissue-sparing technique and
may be an alternative for patients who cannot discontinue these medications.
METHOD: A retrospective cohort study was
performed on patient with chronic rhinosinusitis
who met criteria for surgical intervention after
maximal medical therapy and underwent in-office
balloon sinus dilation while on antiplatelet and
anticoagulant therapy. The patients were
performed awake with a dose of oxycodone given
for 30 minutes prior to the procedure. Topical
anesthesia and decongestion was provided via
cotton-soaked lidocaine 4% and oxymetazoline
0.05% solution instilled in the nares and middle
meatus. 1% lidocaine with 1:100,000 epinephrine
was injected into the axilla of the middle turbinate
and middle meatal mucosal bilaterally. The middle
turbinates were medialized with a Freer elevator.
Under visualization with 3-mm, a 30-degree rigid
nasal endoscope, the balloon catheter device was
inserted into the appropriate sinuses for dilation.
The patients were observed for at least 30
minutes after the procedure in the office area to
evaluate for complications. Sino-Nasal Outcome
Test (SNOT-22) was used to determine the
effectiveness of the procedure. Outcome
measures of risks of bleeding included
postoperative control of hemorrhage, need for
nasal packing, cauterization, emergency room
visits within 30 days, and severe systematic
complications.
RESULTS: During a 2-year period, there were 11
patients with a diagnosis of chronic rhinosinusitis
who underwent the in-office balloon sinus dilation
while on antiplatelet and anticoagulant therapy.
The average score on the SNOT-22 decreased
from 21.8 preoperatively to 17.4 postoperatively.
Two patients were packed in the middle meatus
with absorbable packing for mild bleeding after the
procedure. There was no significant bleeding
events postoperatively after leaving the office,
including no need for packing, cauterization,or
emergency room visits. There were no systemic
complications within 30 days. Two patients
ultimately required endoscopic sinus surgery once
cleared to discontinue antiplatelet and
anticoagulant therapy.
METHOD: We analyzed patients with chronic rhinosinusitis who met criteria for surgical
intervention after maximal medical therapy and underwent in-office sinus dilation while on
antiplatelet and anticoagulant therapy. Sino-Nasal Outcome Test (SNOT-22) was used to
determine the effectiveness of the procedure. Outcome measures of risks of bleeding
included postoperative control of hemorrhage, need for nasal packing, cauterization,
emergency room visits within 30 days, and severe systematic complications.
RESULTS: During a 2-year period, there were 11 patients with a diagnosis of chronic
rhinosinusitis who underwent the in-office balloon sinus dilation while on antiplatelet and
anticoagulant therapy. The average score on the SNOT-22 decreased from 21.8
preoperatively to 17.4 postoperatively. Two patients were packed in the middle meatus with
absorbable packing for mild bleeding after the procedure. There was no significant bleeding
events postoperatively after leaving the office, including no need for packing,cauterization,or
emergency room visits. There were no systemic complications within 30 days. Two patients
ultimately required endoscopic sinus surgery once cleared to discontinue antiplatelet and
anticoagulant therapy.
CONCLUSION: In-office balloon sinus dilation appears to be a safe alternative to
endoscopic sinus surgery in patients who cannot discontinue antiplatelet and anticoagulant
therapy.
Introduction
INTRODUCTION: Due to the high risk of bleeding
in patients taking antiplatelets and anticoagulants,
it is usually recommended that patients
discontinue these medications around the time of
endoscopic sinus surgery. Balloon sinus dilation is
a tissue-sparing technique and may be an
alternative for patients who cannot discontinue
these medications.
Fig. 1. Purulent drainage from right maxillary sinus at
time of balloon dilation procedure despite antibiotic
and steroid therapies. Mild bloody stranding seen.
Contact
Thomas S. Higgins, MD, MSPH
Clinical Assistant Professor, University of Louisville
Rhinologist, Kentuckiana Ear, Nose & Throat, PSC
[email protected]
www.higgins-sinus.com
Discussion
CONCLUSION: In-office balloon sinus dilation
appears to be a safe alternative to endoscopic
sinus surgery in patients who cannot discontinue
antiplatelet and anticoagulant therapy.
Fig. 2. Postoperative 2 weeks after balloon dilation
procedure.