How would you manage HHT with ongoing epistaxis despite IV bevacizumab, with a history of superficial thrombosis?
Has undergone cauterization with ENT, also topical/intranasal bevacizumab, and rose geranium oil. IV bevacizumab was initially helpful, but now with breakthrough epistaxis. Would you consider pomalidomide despite the history of thrombosis? Superficial thrombosis (no DVT) occurred in setting of TXA use, which was discontinued and thrombosis managed conservatively.
Community PollStarted
For refractory HHT-related epistaxis, what is your preferred treatment option?
9 physicians have voted
Join Mednetto vote and see how they answered.
2 Answers
Mednet MemberInvited Expert
Pulmonology · University of Colorado Health
Answered on · Updated on
This is a complex situation with a complex answer, and the patient would likely benefit from establishing care at one of the 30 HHT centers of excellence for a more thorough evaluation. If the patient mentioned has only had cautery, we would consider them seeing an ENT at an HHT center of excellence...
Join for free or sign in to see the full answer
Mednet MemberInvited Expert
Pulmonology · Augusta University Pulmonary Critical Care
Answered on
I agree with Dr. @Dr. First Last here. For example, if the thrombosis was long ago and clearly provoked by a reversible problem like a leg injury, I would not worry about it.
Join for free or sign in to see the full answer