Abstract
Epistaxis is one of the most frequent hemorrhages resulting from local or systemic factors. Its management without hospitalization has prompted an interest in locally applied hemostatic agents. Generally, the therapy approaches involve sprays or creams acting as a physical barrier, even used as tampons or gauze. In this study, we have investigated the activity of Emoxilane®, a combination of sodium hyaluronate, silver salt, α-tocopherol acetate and D-panthenol, which is known to be able to separately act in a different biological manner. Our in vitro results, obtained on endothelial and nasal epithelial cells, have shown that the association of these molecules presented a notable antioxidant activity mainly due to the α-tocopherol and D-panthenol and a significant antimicrobial role thanks to the silver compound. Moreover, remarkable hemostatic activity was found by evaluating plasmin inhibition attributable to the sodium hyaluronate. Interestingly, on human plasma, we have confirmed that Emoxilane® strongly induced the increase of thrombin levels. These data suggest that the use of this association could represent an appealing pharmacological approach to actively induce hemostasis during epistaxis. Our future perspective will aim to the creation of a formulation for an easy topical application in the nose which is able to contrast the bleeding.
Highlights
Hemostasis is a process aimed to arrest a hemorrhage after damage to a blood vessel; when this damage occurs in the nasal mucosa, generating nose bleeding, it is defined as epistaxis
We proved the anti-fibrinolytic effects of Emoxilane® by using the mesoglycan 300 μg/mL as positive control
The amount of thrombin generated kind of analysis allowed us to establish that thrombin, known to be strongly and directly from pro‐thrombin was revealed referring to the standard curve reported in Figure correlated to fibrin clot formation [17], resulted as affected by the molecules of our interest
Summary
Hemostasis is a process aimed to arrest a hemorrhage after damage to a blood vessel; when this damage occurs in the nasal mucosa, generating nose bleeding, it is defined as epistaxis. This latter can result from local or systemic factors, mainly traumatic, neoplastic, hematological, inflammatory ones, or therapies with anticoagulants and antiplatelet drugs [1]. Refractory bleeding makes endoscopic surgery necessary as cauterization or ligation of the bleeding blood vessel performed by an otolaryngologist. If even these techniques are not successful, recourse must be made to the intervention of radiologists for digital subtraction angiography (DSA) and embolization of the blood vessel that causes the bleeding [3,4]
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