Safely Treating a Pulmonary Embolism in a Patient With Hereditary Hemorrhagic Telangiectasia: A Case Report

Hereditary Hemorrhagic Telangiectasia (HHT) is a rare autosomal dominant bleeding disorder. The incidence of venous thromboembolisms among HHT patients is significantly greater than the general population. However, providing therapeutic anticoagulation in patients with an increased propensity for bleeding creates a clinical dilemma. This is a case of a 58-year-old Caucasian female with a past medical history of HHT who was diagnosed with acute on chronic bilateral pulmonary embolisms. She was started on therapeutic anticoagulation after thoroughly considering the individual bleeding risks. She later developed upper gastrointestinal bleeding secondary to angioectasias in the stomach and duodenum that were treated with argon plasma coagulation. The patient completed a total of 6 months of therapeutic anticoagulation and another year of lower dose anticoagulation for secondary prevention. This case exemplifies that patients with HHT may be treated with anticoagulation after thorough risk benefit discussions and close monitoring for acute blood loss, as recommended by current guidelines. However, these guidelines are informed by low quality evidence and there is a lack of detailed data reported in current literature. Future studies directly comparing the safety of different anticoagulants among HHT patients are needed to inform clinical practice.