Anticoagulation and Antiplatelet Therapy in Hereditary Hemorrhagic Telangiectasia

When a patient with HHT develops a concurrent indication for anticoagulation or antiplatelet therapy, clinicians face a distinctive management question: how to address the thrombotic or cardiovascular indication without dismissing the bleeding risks inherent to HHT.

The patient has HHT and a prophylactic or therapeutic indication for anticoagulation, or an indication for antiplatelet therapy. Expert guidance is clear that bleeding in HHT is not an absolute contraindication for these therapies — but individualized bleeding risk assessment is central to the decision.

The structured protocol specifies which classes of anticoagulant agents are preferred in this population over others, and provides guidance on antiplatelet therapy — including the circumstances under which particular combinations should be avoided. The full algorithm and agent-selection rationale are in the complete protocol.