Managing Recurrent Epistaxis in Hereditary Hemorrhagic Telangiectasia (HHT)

Recurrent nosebleeds are the hallmark presentation in patients with HHT. This page outlines the clinical context and directs clinicians to a structured, evidence-based regimen for this common and often disabling manifestation.

Clinical scenario: Recurrent epistaxis occurring in the setting of hereditary hemorrhagic telangiectasia. Epistaxis is the most common manifestation of HHT, affecting the great majority of adults with the condition, and may range from frequent mild bleeds to severe, life-affecting episodes.

Approach overview A first-line approach involves moisturizing therapies directed at the nasal mucosa. The complete regimen — including the full range of interventions considered and how they are applied — is available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1182/blood.2020008739

Recurrent and often severe epistaxis is the most common manifestation of HHT, occurring in >90% of adults.

Moisturization of the nasal mucosa through air humidification and topical application of saline solution or gels is a mainstay of epistaxis prevention to reduce cracking and bleeding of fragile telangiectasias, but that treatment alone is inadequate for many patients.

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