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International HHT Guidelines

Published September 8, 2020 in the Annals of Internal Medicine

Here to Disseminate!

New HHT International Guidelines Released

Announcing the Second International HHT Guidelines for the Diagnosis and Management of HHT, published in the Annals of Internal Medicine. The Guidelines were developed by an international panel of HHT experts and patients, providing new evidence-based consensus recommendations in six priority topic areas: Epistaxis, Gastrointestinal Bleeding, Anemia & Iron Deficiency, Liver VMs, Pediatric Care, Pregnancy & Delivery. The 2020 Guidelines add to the First International HHT Guidelines published in 2009, most notably in areas that were not re-assessed in 2020: HHT Diagnosis, Brain VMs and Pulmonary AVMs. The HHT Guidelines recommendations should facilitate the implementation of key components of HHT (Hereditary Hemorrhagic Telangiectasia) care into clinical practice.

Explore Guidelines by Topic

Browse to see the recommendations and background for each topic.

  • Epistaxis (Nosebleeds)

    Epistaxis is the most common symptom of HHT. It can have a  devastating effect on quality of life and lead to iron deficiency and anemia. These nine recommendations are focused on reducing epistaxis.

  • GI Bleeding Management

    GI bleeding develops in approximately 30% of HHT patients. These six recommendations cover testing and managing GI bleeding.

  • Anemia & Anticoagulation

    Anemia is a common complication in people with HHT. These six guidelines cover testing and treatment of iron deficiency and anemia, as well as the use of anticoagulation therapy.

  • Liver VM's

    Liver VMs occur in approximately 75% of HHT patients, and are more common in women. These seven recommendations cover screening, diagnosis and management.

  • Pediatric Care

    Potentially serious and life-threatening complications from HHT--pulmonary AVMs and brain VMs -- can occur at any age. As such, these guidelines focus on their screening and management in children.

  • Pregnancy & Delivery

    Pregnant women with HHT should be assessed for their risk of pregnancy and delivery-related complications and should have access to, as needed, a multidisciplinary team that includes HHT experts.

  • Diagnosis of HHT

    Timely diagnosis of HHT allows for the appropriate screening and preventative treatment for the individual with HHT and their family members.

  • Pulmonary AVM's

    At least 40% of people with HHT have pulmonary AVMs. They are often unaware until they develop a life-threatening complication. Screening and treatment can prevent life-threatening complications.

  • Brain VM's

    At least 10% of people with HHT have VMs in the brain blood vessels. They are often unaware of these brain VMs until they develop a life-threatening complication.

Introduction & Methods

Background on HHT and the process for developing the Second International Guidelines, including patient involvement.

Funding Sources & Competing Interests

See the funding sources for the Second International Guidelines process, their role, competing interests and contributors.

Authors & Author Affiliations

See the full list of authors for the Second International Guidelines and their affiliations.

Future Research & Guidelines Priorities

See the list of priorities for future guidelines and research, identified in the Second International Guidelines


Of the Second International HHT Guidelines. Click for all Endorsements. 
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