An Alternative Solution to a Difficult Problem

Abstract

Hereditary haemorrhagic telangiectasia (HHT) is a rare disorder composed of mucocutaneous telangiectasia, recurrent epistaxis, gastrointestinal haemorrhage and a family history. Patients with HHT are at increased risk of stroke due to vascular malformations but can also have ‘classical’ risk factors such as atrial fibrillation. Oral anticoagulation with warfarin or direct acting oral anticoagulants may not be suitable in all patients for the prevention of recurrent stroke in atrial fibrillation. The increased risk of bleeding with HHT can have a significant impact on therapeutic options. Percutaneous left atrial appendage occlusion or open left atrial amputation or occlusion can be considered in select cases but long term conclusive evidence about risks and benefits from randomized controlled trials is currently limited.