Terence Davidson, M.D., Head & Neck Surgeon with the University of California San Diego, says over time, patients with Hereditary hemorrhagic telangiectasia (HHT) tend to have more frequent and severe nosebleeds, losing as much as one to two pints of blood at a time. They may need intravenous iron and emergency transfusions to replace the lost blood.
Controlling the bleeding can be difficult. Doctors may place packing in the nose to reduce blood loss. If that doesnít help, a laser may be used to coagulate blood and seal the leaking vessels. In septal dermoplasty, the mucous membrane lining the nose is replaced with a graft of skin. This is a permanent procedure to reduce the severity and frequency of nosebleeds. Davidson says, for the most severe cases that donít respond to treatment, doctors may recommend suturing the nose shut. Although this procedure works well, itís typically used only as a last resort option because patients lose their ability to smell and breathe through their nose.
A novel treatment being tested for severe or recurrent HHT-related nosebleeds is Avastin, a medication initially developed to treat colon cancer. The drug works by inhibiting the growth of new blood vessels. For patients with severe bleeding, the medication is given through an injection in the nose. Davidson explains an injection can be uncomfortable, so the procedure is done in an operating room while the patient is under anesthesia. He uses an endoscope (lighted viewing tube) to see inside the nose and deliver the injection to the area of bleeding. For mild cases of nosebleed, Avastin can be given in the form of a nasal spray. The nasal spray is given in the physicianís office.
Davidson says Avastin injections work very well and reduce the risk of bleeding for at least a year. In some cases, the effect lasts for two or more years. By contrast, laser treatments last only about three to four months.
Currently, Avastin is being used off-label for HHT nosebleeds. The University of California San Diego is the only center in the U.S. testing the drug for this purpose. There are two ongoing studies. In the first study, patients receive laser treatment and an injection of Avastin. Participants in the second study will receive a topical Avastin spray. For information about the studies, go here.