What are the current management strategies for recurrent epistaxis in patients with HHT?

Management of recurrent epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT) involves a stepwise approach combining local, medical, and sometimes surgical interventions tailored to severity and frequency of bleeding episodes. Initial strategies focus on conservative measures such as humidification, nasal lubrication, and avoidance of nasal trauma to reduce mucosal fragility and bleeding risk NICE CG141 Faughnan et al. 2011. For more persistent or severe epistaxis, topical therapies including tranexamic acid and estrogen creams may be employed to promote mucosal stability and reduce bleeding frequency NICE CG141 Garg et al. 2014. When these measures are insufficient, endoscopic laser ablation or electrocautery of telangiectatic lesions within the nasal mucosa is recommended to directly control bleeding sites NICE CG141 Viteri-Noël et al. 2022. In refractory cases, more invasive options such as septodermoplasty or nasal closure (Young’s procedure) can be considered to significantly reduce epistaxis severity, though these carry higher morbidity and impact on nasal function NICE CG141 Faughnan et al. 2011. Systemic therapies, including antiangiogenic agents like bevacizumab, have shown promise in reducing epistaxis frequency and severity by targeting abnormal vascular proliferation, and may be considered in selected patients with severe, recurrent bleeding unresponsive to local treatments Garg et al. 2014 Viteri-Noël et al. 2022. Overall, management is multidisciplinary, often requiring ENT specialists, hematologists, and geneticists to optimize outcomes and address associated complications NICE CG141 Faughnan et al. 2011.