Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.792
Peer-review started: August 5, 2016
First decision: August 26, 2016
Revised: September 7, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 27, 2016
We report a case of severe, refractory gastrointestinal (GI) bleeding in a patient with hereditary hemorrhagic telangiectasia (HHT) whose massive transfusion dependence was lifted shortly after treatment with bevacizumab, an anti-vascular endothelial growth factor. The patient’s bleeding had been refractory to repeated endoscopic interventions, tranexamic acid, and tamoxifen. However, following treatment with bevacizumab at 5 mg/kg every other week, nearly 300 units of packed red blood cell transfusions were avoided in one year’s time. Despite its relatively high cost, bevacizumab may have a more active role in the management of severe GI bleeding in HHT if such remarkable response can be consistently demonstrated.
Core tip: Management of gastrointestinal (GI) bleeding in patients with hereditary hemorrhagic telangiectasia (HHT) can be challenging when the vascular lesions recur despite repeated endoscopic treatments. There is increasing evidence supporting the use of anti-angiogenesis agents in the management of bleeding in HHT patients. Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, has been shown to reduce recurrent epistaxis. This case demonstrates the therapeutic potential of bevacizumab in patients with severe GI bleeding requiring massive transfusions.