Publication:

A delicate balance: hereditary hemorrhagic telangiectasia and antiphospholipid syndrome in pregnancy with dual therapy

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.