Epistaxis is a primary complaint in 90% to 96% of patients with hereditary HHT. Numerous surgical and medical treatments aim to decrease the frequency and severity of epistaxis in this patient population. It has been used in several forms to treat epistaxis in HHT, but thus far, evidence-based recommendations are limited.

The study design a systematic review with evidence-based recommendations.

The present study was a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using Embase, MEDLINE, MEDLINE In-Process/Epub, and Cochrane databases. English language abstracts were reviewed for relevance.

Eleven manuscripts met inclusion criteria and were analyzed. Submucosal injection, submucosal injection, laser coagulation, intravenous (IV), and topical formulations were evaluated. Three randomized controlled trials failed to show topical bevacizumab to be more effective in controlling epistaxis than saline or other moisturizers.

The study concluded that the use of submucosal and IV bevacizumab shows promise. Still, further research is necessary to determine the real efficacy of treating epistaxis as only grade C level exists. Based on the available literature, the use of topical bevacizumab is not recommended (grade B).

Reference: https://journals.sagepub.com/doi/full/10.1177/1945892418768588