A delicate balance: hereditary hemorrhagic telangiectasia and antiphospholipid syndrome in pregnancy with dual therapy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262134Keywords:
Hereditary hemorrhagic telangiectasia, Antiphospholipid Syndrome, Pregnancy, Hemoptysis, Nebulized tranexamic acid, High-risk pregnancyAbstract
Hereditary hemorrhagic telangiectasia (HHT) and antiphospholipid syndrome (APS) are two rare disorders that present a challenge during pregnancy due to the competing risks of bleeding and thrombosis. This case presents a 26-year-old female, gravida 3, para 0-1-1-1, with a past medical history of HHT and APS receiving prophylactic anticoagulation. The patient presented to the antepartum ward (APW) at 32.1 weeks of gestation with complaints of hemoptysis and epistaxis. During this evaluation, nebulized tranexamic acid (TXA) was added as a treatment without interruption of anticoagulation therapy. This management resulted in complete resolution of symptoms without maternal or fetal complications. Therefore, nebulized TXA may represent a safe therapeutic option for hemoptysis in pregnant patients with HHT who require anticoagulation for APS. The findings highlight the importance of individualized, multidisciplinary care in a setting of complex diseases.
References
Locke T, Gollamudi J, Chen P. Hereditary Hemorrhagic Telangiectasia (HHT). In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2026.
Andorfer KEC, Seebauer CT, Dienemann C, Marcrum SC, Fischer R, Bohr C, et al. HHT-Related Epistaxis and Pregnancy-A Retrospective Survey and Recommendations for Management from an Otorhinolaryngology Perspective. J Clin Med. 2022;11(8):2178.
Committee on Practice Bulletins—Obstetrics, American College of Obstetricians and Gynecologists. Practice Bulletin No. 132: Antiphospholipid syndrome. Obstet Gynecol. 2012;120(6):1514-21.
Peitsidis P, Kadir RA. Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother. 2011;12(4):503-16.
Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018;154(6):1379-84.
Zhang P, Zheng J, Shan X, Zhou B. Advances in the study of nebulized tranexamic acid for pulmonary hemorrhage. Eur J Clin Pharmacol. 2025;81(2):237-46.
McDonald J, Bayrak-Toydemir P, DeMille D, Wooderchak-Donahue W, Whitehead K. Curaçao diagnostic criteria for hereditary hemorrhagic telangiectasia is highly predictive of a pathogenic variant in ENG or ACVRL1 (HHT1 and HHT2). Genet Med. 2020;22(7):1201-5.
Ye M, Chen M, Wang C, Jiang Z, Luo H, Ren Y. Nebulized Tranexamic Acid in the Management of Hemoptysis: An Integrative Review. Lung. 2025;203(1):28.
Eltahir M, Elshafei MN, Elzouki A. Inhaled Tranexamic Acid for Non-Massive Haemoptysis in a Rivaroxaban-Receiving Patient Not Responding to the Oral Form. Eur J Case Rep Intern Med. 2020;7(12):001930.
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