Tranexamic Acid and Bevacizumab in Hereditary Hemorrhagic Telangiectasia Patients Presenting With Epistaxis [letter]

We congratulate Flanagan et al and wish to make some comments on their article, "Intranasal Tranexamic Acid for the Treatment of Hereditary Hemorrhagic Telangiectasia: A Case Report and Review of Treatment Options" (Cutis. 2012;89:69-72). Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is an autosomal-dominant disorder characterized by the development of multiple arteriovenous malformations (AVMs). Hereditary hemorrhagic telangiectasia should be clinically diagnosed on the basis of the Curaçao criteria, of which 3 criteria must be fulfilled: (1) multiple mucocutaneous telangiectases; (2) epistaxis; (3) visceral involvement; (4) family history of HHT. Paradoxical embolism from pulmonary AVM is one of the main causes of morbidity.