Bleeding and clotting in hereditary hemorrhagic telangiectasia

Figure 1 Arrows indicate telangiectatic lesions on tongue and lip of patient.

Figure 2 Diagnostic algorithm incorporating the Curacao criteria and genetic testing. HHT: Hereditary hemorrhagic telangiectasia.

Figure 3 Coagulation cascade. Factors Xa and IIa (thrombin) are the principal targets for the new oral anticoagulants, while factors II, VII, IX, X, and protein C and S are decreased by the vitamin K antagonist, warfarin. Warfarin’s effect on the factor VIIa/TF complex is a possible cause of the increased intracranial bleeding seen in warfarin compared to the newer targeted agents.