Treatments of Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Network Meta-Analysis

Curr Allergy Asthma Rep. 2023 Dec;23(12):689-701. doi: 10.1007/s11882-023-01116-8. Epub 2023 Nov 23.


Purpose of review: To analyze and compare the effects of epistaxis treatments for Hereditary Hemorrhagic Telangiectasia (HHT) patients.

Recent findings: Of total of 21 randomized controlled trials (RCT), the data from 15 RCTs (697 patients, 7 treatments: timolol, propranolol, bevacizumab, doxycycline, tacrolimus, estriol/estradiol, and tranexamic acid) were pooled for the meta-analyses while the other 6 studies (treatments: electrosurgical plasma coagulation, KTP laser, postoperative packing, tamoxifen, sclerosing agent, and estriol) were reviewed qualitatively. When compared to placebo, propranolol offered the most improved epistaxis severity score, mean difference (MD), -1.68, 95% confidence interval (95%CI) [-2.80, -0.56] followed by timolol, MD -0.40, 95%CI [-0.79, -0.02]. Tranexamic acid significantly reduced the epistaxis frequency, MD -1.93, 95%CI [-3.58, -0.28]. Other treatments had indifferent effects to placebo. Qualitative analysis highlighted the benefits of tamoxifen and estriol. The adverse events of tranexamic acid, tacrolimus, propranolol, and estradiol were significantly reported. Propranolol, timolol, tranexamic acid, tamoxifen, and estriol were effective treatments which offered benefits to HHT patients in epistaxis management. Adverse events of tranexamic acid, tacrolimus, propranolol, and estradiol should be concerned.

Keywords: Epistaxis; HHT; Meta-analysis; Quality of life; Therapeutics.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Epistaxis / drug therapy
  • Epistaxis / therapy
  • Estradiol / therapeutic use
  • Estriol / therapeutic use
  • Humans
  • Network Meta-Analysis
  • Propranolol / therapeutic use
  • Tacrolimus / therapeutic use
  • Tamoxifen / therapeutic use
  • Telangiectasia, Hereditary Hemorrhagic* / complications
  • Telangiectasia, Hereditary Hemorrhagic* / drug therapy
  • Timolol / therapeutic use
  • Tranexamic Acid* / therapeutic use


  • Tranexamic Acid
  • Timolol
  • Propranolol
  • Tacrolimus
  • Estriol
  • Estradiol
  • Tamoxifen