Friday, August 3, 2012

Anticoagulant and Nasodren


Cavernous sinus thrombosis (CST) represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical. 
Cavernous sinus thrombosis may result from any infection of the tissue drained by the cavernous sinus. This includes the midface, orbit and sinonasal cavity. The mortality rate remains high at 30%, and significant morbidity includes residual cranial nerve palsies and blindness. 
Treatment for cavernous sinus thrombosis includes high-dose intravenous antibiotics directed at the most common causative organisms, coupled with surgical drainage of the primary source of infection.




 The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that     haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the      haemorrhagic sequelae of CST radiologically. 
After application of NASODREN®, a slight issuing of red blood cells in the nose was observed in some patients. Therefore, treatment with anticoagulants (e.g. coumarin derivatives, acetylsalicylic acid) should be suspended, taking account of the rate of elimination of the particular anticoagulant.

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