{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:05:00Z","timestamp":1787799900065,"version":"build-2784847793"},"reference-count":67,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T00:00:00Z","timestamp":1517529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder resulting in vascular dysplasia and formation of arteriovenous malformations. Recurrent epistaxis is a hallmark of the disease. An array of medical therapies are used in this patient population, but robust evidence\u2010based recommendations regarding the medical treatment of epistaxis are lacking. This systematic review was performed to look at the current literature and make meaningful evidence\u2010based recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A search of the Ovid MEDLINE, Embase, and Cochrane databases was conducted by a research librarian. Abstracts in the English language and published in a peer\u2010review journal were reviewed for relevance and inclusion. PRISMA guidelines were followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen studies met the inclusion criteria. In a few small studies, thalidomide was shown to consistently improve severity and frequency of epistaxis and improve hemoglobin concentrations while decreasing the need for transfusion. Tranexamic acid appeared to only impact the epistaxis severity score and not other clinical outcomes. Selective estrogen modulators (SERMs), propranolol, rose geranium oil, and\n                      <jats:italic>N<\/jats:italic>\n                      \u2010acetylcysteine, have demonstrated promising efficacy in small trials.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Appropriate medical therapies for epistaxis outcomes in HHT remain undefined, and there is no \u201cgold standard.\u201d Many of the studies are small and the data reported are heterogeneous, and therefore the ability to make strong evidence\u2010based recommendations is limited. However, many different medications appear to be promising options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.22094","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T11:52:39Z","timestamp":1517572359000},"page":"713-728","source":"Crossref","is-referenced-by-count":19,"title":["Medical treatment of epistaxis in hereditary hemorrhagic telangiectasia: an evidence\u2010based review"],"prefix":"10.1002","volume":"8","author":[{"given":"Ashleigh A.","family":"Halderman","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern  Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern  Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern  Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Sindwani","sequence":"additional","affiliation":[{"name":"Head and Neck Institute Cleveland Clinic Foundation  Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas D.","family":"Reh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Hospital  Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Poetker","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication Sciences Medical College of Wisconsin  Milwaukee WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosangela","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley F.","family":"Marple","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern  Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.1999.00398.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3917\/pope.902.0273"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/humu.10026"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.10002"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8628(20000306)91:1<66::AID-AJMG12>3.0.CO;2-P"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng0696-189"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng1294-345"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.79.927.18"},{"key":"e_1_2_7_10_1","first-page":"3487","article-title":"Real\u2010time imaging of de novo arteriovenous malformation in a mouse model of hereditary hemorrhagic telangiectasia","volume":"119","author":"Park S","year":"2009","journal-title":"J Clin Invest"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.109.211037"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199510053331407"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.1320320302"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino09.138"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino10.090"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-004-7865-y"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/194589240501900112"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20095"},{"key":"e_1_2_7_19_1","unstructured":"Oxford Centre for Evidence\u2010based Medicine (CEBM)\u2014Levels of Evidence.2009.http:\/\/www.cebm.net\/oxford-centre-evidence-based-medicine-levels-evidence-march-2009\/.Accessed September 30 2016."},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1260"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20818"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.006"},{"issue":"1","key":"e_1_2_7_23_1","first-page":"1","article-title":"Cochrane methods","author":"Chandler J CM","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1952.02930320016006"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198203000-00017"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100094354"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2005.06.029"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.518621"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH09-07-0425"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20065"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino09.201"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(03)00361-9"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcmed.2005.03.037"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489.2015.1129070"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.11724"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0901505106"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biocel.2007.01.022"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2003.029710"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e32832c9346"},{"key":"e_1_2_7_41_1","first-page":"21","article-title":"Using thalidomide in a patient with epithelioid leiomyocarcoma and Osler\u2010Weber\u2010Rendu disease","volume":"16","author":"Kurstin R","year":"2002","journal-title":"Oncology"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm.2131"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(15)00195-7"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.169068"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817700573"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/MBC.0b013e32834a040c"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199807233390407"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/0005-2795(75)90216-0"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-4165(81)90312-3"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-198529030-00003"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.107.4.571"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH06-07-0373"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-014-2169-y"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2014.06.012"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12654"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2008.03638.x"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60835-5"},{"key":"e_1_2_7_58_1","unstructured":"RiviereS PelencD Dupuis\u2010GirodS et\u00a0al.Hereditary hemorrhagic telangiectasia and venous thromboembolism. Hematology meeting reports. In: Proceedings of the 8th International Hereditary Hemorrhagic Telangiectasia Scientific Conference in Santander Spain 2009;3:54."},{"key":"e_1_2_7_59_1","first-page":"818","article-title":"Patients with hereditary hemorrhagic telangiectasia have increased plasma levels of vascular endothelial growth factor and transforming growth bactor\u2010beta1 as well as high ALK1 tissue expression","volume":"90","author":"Sadick H","year":"2005","journal-title":"Haematologica"},{"key":"e_1_2_7_60_1","first-page":"591","article-title":"Plasma level and tissue expression of angiogenic factors in patients with hereditary hemorrhagic telangiectasia","volume":"15","author":"Sadick H","year":"2005","journal-title":"Int J Mol Med"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2010.09848.x"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH11-11-0809"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0708819"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12821"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-017-0235-x"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.0000159936.38601.22"},{"key":"e_1_2_7_67_1","first-page":"85","article-title":"The effect of N\u2010acetylcysteine on epistaxis and quality of life in patients with HHT: a pilot study","volume":"47","author":"Gussem EM Snijder RJ","year":"2009","journal-title":"Rhinology"},{"key":"e_1_2_7_68_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23736"}],"container-title":["International Forum of Allergy &amp; Rhinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Falr.22094","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.22094","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T11:29:52Z","timestamp":1695468592000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/alr.22094"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,2]]},"references-count":67,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1002\/alr.22094"],"URL":"https:\/\/doi.org\/10.1002\/alr.22094","archive":["Portico"],"relation":{},"ISSN":["2042-6976","2042-6984"],"issn-type":[{"value":"2042-6976","type":"print"},{"value":"2042-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,2]]}}}