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Double bypass, respiratory failure, nose bleeds, selective embolization

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Posted on Sat, 19 May 2012
Question: In XXXXXXX 2011 my father had two valves replaced with mechanical ones, one valve repaired and a double bypass. His chest was reopened that night d/t bleeding and a week later to rewire his chest (went into cardiac/resp failure and they did CPR). My father was on Coumadin before the surgery for A-fib. He continues on Aspirin and Coumadin. The problem is the severe nose bleeds since the surgery. We have tried everything: cold keys hanging down his back, ice packs, premarin cream in his nose, olive oil sprayed into nose, various nose sprays and packings, constant humidification, no hot foods, increase of blood pressure meds, silver nitrate sticks. HELP. Tonights nose bleed sent him to the ER again
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Answered by Dr. Sumit Bhatti (5 hours later)
Dear XXXXXXX

Thank you for your query,

There are a few details which will help establish the preferred mode of treatment:
1. Is his epistaxis (bleeding from nose) one sided or from both sides? Is his blood pressure under control?
2. Has there been a drop in hemoglobin? What is his hematocrit (packed cell volume)? A coagulogram which includes a platelet count, bleeding time (BT), clotting time (CT), PT (Prothrombin Time) and PTTK (Partial Thromboplastin Time with Kaolin) must have been done. What are the latest values?
3. His coagulogram is bound to be deranged as he is on blood thinning and anti coagulation drugs secondary to his cardiac condition.
4. Does he bleed only from the nostrils or does blood come into his throat and mouth? The differentiation between an anterior and posterior bleed is important.
5. Is the blood bright red (arterial) or dark (venous bleed)? Does he expel clots from his nose or is the blood very thin?
Since you have tried most of the supportive medication and treatments, we need to look at specific medication to reduce bleeding such as ethamsylate, tranexamic acid , botropase and Vitamin K.
A nasal endoscopy to localize the bleed and to cauterize or ligate the bleeding points may be required. However, the above mentioned test results will be required to decide whether he is surgically fit to undergo the procedure.

Selective embolization is another option.

Hope I have answered your query. If you follow up with his test results, I will be available to answer any further questions.

Regards.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2652 Questions

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Double bypass, respiratory failure, nose bleeds, selective embolization

Dear XXXXXXX

Thank you for your query,

There are a few details which will help establish the preferred mode of treatment:
1. Is his epistaxis (bleeding from nose) one sided or from both sides? Is his blood pressure under control?
2. Has there been a drop in hemoglobin? What is his hematocrit (packed cell volume)? A coagulogram which includes a platelet count, bleeding time (BT), clotting time (CT), PT (Prothrombin Time) and PTTK (Partial Thromboplastin Time with Kaolin) must have been done. What are the latest values?
3. His coagulogram is bound to be deranged as he is on blood thinning and anti coagulation drugs secondary to his cardiac condition.
4. Does he bleed only from the nostrils or does blood come into his throat and mouth? The differentiation between an anterior and posterior bleed is important.
5. Is the blood bright red (arterial) or dark (venous bleed)? Does he expel clots from his nose or is the blood very thin?
Since you have tried most of the supportive medication and treatments, we need to look at specific medication to reduce bleeding such as ethamsylate, tranexamic acid , botropase and Vitamin K.
A nasal endoscopy to localize the bleed and to cauterize or ligate the bleeding points may be required. However, the above mentioned test results will be required to decide whether he is surgically fit to undergo the procedure.

Selective embolization is another option.

Hope I have answered your query. If you follow up with his test results, I will be available to answer any further questions.

Regards.