Rapid diagnosis of sinonasal cancer in an anticoagulated patient: Outpatient clinical use of a gelatin-thrombin matrix (Floseal) for hemostasis following endonasal tumor biopsies Shaun J Kilty ABSTRACT Introduction: The purpose of this case report is to describe the use of gelatin-thrombin matrix (Floseal) for hemostasis to control severe nasal bleeding following endonasal biopsies in an elderly patient receiving anticoagulant therapies. Case Report: An 81-year-old woman with advanced Alzheimer’s disease presented with rapid onset of midfrontal swelling, pain and orbital hypertelorism. Profuse bleeding occurred following tumor biopsies in the outpatient clinic which was controlled in less than five minutes with a single administration of Floseal. The pathologic diagnosis was diffuse large B-cell lymphoma and treatment was initiated within the week. There was no recurrence of bleeding following this single treatment. The use of Floseal safely and economically allowed for rapid diagnosis and treatment of this sinonasal cancer without the need to stop and restart anticoagulation therapy in an elderly patient with dementia. Conclusion: The outcome from the clinical management of this case suggests that this treatment approach may be a model for use in the rapid diagnosis of sinonasal pathology in the outpatient clinic even in the setting of anticoagulation. Keywords: Floseal matrix, Hemostasis, Biopsy, Anticoagulants, Diagnosis, Warfarin, Aspirin, Paranasal sinuses ********* Kilty SJ. Rapid diagnosis of sinonasal cancer in an anticoagulated patient: Outpatient clinic use of a gelatin-thrombin matrix (Floseal) for hemostasis following endonasal tumor biopsies. International Journal of Case Reports and Images 2011;2(11):10-13. ********* doi:10.5348/ijcri-2011-11-65-CR-3 INTRODUCTION Floseal (FloSeal Hemostatic Matrix; Baxter Healthcare Corporation, Deerfield, IL, USA) comprises a gelatin matrix containing a reconstituted thrombin solution [1]. This topical hemostatic agent has been found to be useful for both problematic and severe bleeding encountered during surgery and other procedures at various anatomical sites [1]. Although the utility of this agent has been well described in the surgical setting, it may also have numerous clinical applications. This case report is the first to describe the use of Floseal in an anticoagulated elderly patient in an outpatient clinic, who required endonasal biopsy of a rapidly expanding sinonasal cancer to control the resultant bleeding. CASE REPORT An 81-year-old woman was referred to the clinic for treatment of chronic rhinosinusitis (CRS). She had a history of recurrent pulmonary embolus and venous thrombosis from hereditary thrombophilia. Three years previously she had been diagnosed with Alzheimer’s www.ijcasereportsandimages.com