Antiplatelet and Anticoagulant Agents in Hereditary Hemorrhagic Telangiectasia

Abstract

T h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 368;9 nejm.org february 28, 2013

Left atrial appendage closure in patients with osler disease and atrial fibrillation

“…The two studiers associated fewer device and procedure-related risks in LAAc with improvement in operative experience [27]. observation study on the Lariant device also finds LAA closure has low access complications and peri-procedural adverse events while Devlin et al [28]. found antiplatelet aggregation therapy more valuable than OAC for Osler patients after undergoing percutaneous LAA closure.…”

Dietary supplement use and nosebleeds in hereditary haemorrhagic telangiectasia ‒ an observational study

“…The study participants appeared to demonstrate subtle differences in platelet activity, although differences in epistaxis scores did not emerge in the small cohorts. High proportions of HHT patients avoid therapeutic antiplatelet and anticoagulant agents, often on medical advice (26). It is not known whether any potential antiplatelet activity for example, from Omega-3 compounds (22)(23)(24)(25), would be sufficient to exacerbate HHT nosebleeds in the subgroup of individuals who report that their HHT nosebleeds are exacerbated by aspirin and/or clopidogrel (26).…”

“…High proportions of HHT patients avoid therapeutic antiplatelet and anticoagulant agents, often on medical advice (26). It is not known whether any potential antiplatelet activity for example, from Omega-3 compounds (22)(23)(24)(25), would be sufficient to exacerbate HHT nosebleeds in the subgroup of individuals who report that their HHT nosebleeds are exacerbated by aspirin and/or clopidogrel (26). We are however, unaware of any medical recommendation for their use in haemorrhagic disorders, and in the clinic, find patients to be surprised and concerned that these "healthy supplements" may act as natural blood thinners.…”

Hereditary haemorrhagic telangiectasia

“…Treatment algorithms have been proposed (62,66) , based on the severity of bleeding, but patient choice is also (25,67) .…”