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Scientific Oral Presentations

Rhinology/Allergy

Session: Scientific Oral Presentations 2 - Rhinology/Allergy

Navigating Risk in Atrial Fibrillation and Hereditary Hemorrhagic Telangiectasia: Antithrombotic vs Antifibrinolytic Therapy

Sunday, October 12, 2025
1:12 PM - 1:18 PM EDT
Location: 125
Disclosure(s):
Avraham E. Adelman, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Atrial fibrillation (AF) significantly increases the risk of thromboembolism and stroke. In hereditary hemorrhagic telangiectasia (HHT), increased bleeding risk complicates the management of antithrombotic therapy for AF. Uncertainty also exists regarding the safety of oral tranexamic acid (TXA) in HHT patients with AF due to thrombotic concerns, with no established guidelines. We aimed to evaluate the safety and tolerability of antithrombotic and TXA therapy in patients with comorbid AF and HHT.

Methods: A retrospective review was performed on all HHT patients treated at our institution between 2011 and 2024. Patients with concurrent AF were identified, and data was collected on HHT characteristics, AF management, and tolerability of antithrombotic and TXA therapy.

Results: There were 32 patients included, with a mean age of 72 years and male predominance (53.1%). The most common known HHT genotypes were ACVRL (43.8%) and ENG (18.8%). Patients had a history of epistaxis (100%), gastrointestinal bleeding (GIB, 50%), and underwent left atrial appendage procedures (46.9%). Anticoagulation (AC) was attempted in 12 patients, with 25% being co-prescribed antiplatelet therapy. Premature AC discontinuation or dose reduction occurred in 58% of cases due to worsening epistaxis (n=3), leg bruising (n=2), GIB (n=1), or anemia (n=1). Among remaining patients, thrombotic complications included deep vein thrombosis (n=3), embolic ischemic stroke (n=1), and thromboembolic pulmonary hypertension (n=1). 15 patients were explicitly not prescribed AC due to HHT-related concerns, despite therapy being indicated. Prescribed or approved by outside cardiologists, 11 patients had been taking oral TXA for a mean of 1.3 years (650-1,300 mg three times daily), without reported complications.

Conclusions: Guidelines recommend antithrombotic therapy when indicated; however, we found poor tolerability and a hesitancy to prescribe AC. In contrast, oral TXA appeared well-tolerated in this small cohort. Further studies are needed to assess the safety and efficacy of both AC and TXA in this unique population.

    Presenting Author(s)

  • AA

    Avraham E. Adelman, BS

    Medical Student
    Florida Atlantic University Schmidt College of Medicine
    Boca Raton, Florida, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • LR

    Landon G. Richardson, n/a

    Medical Student
    University of Florida College of Medicine
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • Lindsey F. Jackson

    Medical Student
    University of Florida College of Medicine
    Gainesville, FL, United States

    Disclosure information not submitted.

  • AM

    Akshay Mathavan, MD

    Dr.
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • AM

    Akash Mathavan, MD

    University of Florida, Florida, United States

    Disclosure information not submitted.

  • AA

    Ali Ataya, MD

    University of Florida, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • JJ

    Jeb M. Justice, MD

    Associate Professor
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.