Coagulopathy and related complications following sclerotherapy of congenital venous malformations

Rachel F Swerdlin; Michael A Briones; Anne E Gill; C Matthew Hawkins

doi:10.1002/pbc.29610

Coagulopathy and related complications following sclerotherapy of congenital venous malformations

Pediatr Blood Cancer. 2022 May;69(5):e29610. doi: 10.1002/pbc.29610. Epub 2022 Mar 2.

Authors

Rachel F Swerdlin¹, Michael A Briones^{1

2}, Anne E Gill^{1

3}, C Matthew Hawkins^{1

3}

Affiliations

¹ Children's Healthcare of Atlanta, Vascular Anomalies Clinic, Atlanta, Georgia, USA.
² Division of Pediatric Hematology-Oncology, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University Medical Center and Children's Pediatric Institute, Atlanta, Georgia, USA.
³ Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University Medical Center and Children's Pediatric Institute, Atlanta, Georgia, USA.

PMID: 35234344
DOI: 10.1002/pbc.29610

Abstract

Background: Congenital venous malformations (VMs) are low-flow vascular anomalies that can cause coagulation abnormalities. This phenomenon, referred to as localized intravascular coagulopathy (LIC), is characterized by elevated D-dimer, hypofibrinogenemia, and/or thrombocytopenia. Increased risk for LIC includes patients with an extensive VM, multifocal VM, and Klippel-Trenaunay and CLOVES syndromes. Peri-procedural anticoagulation has been given to prevent complications from LIC in patients undergoing surgical/interventional procedures; however, the rate of clinically relevant complications from sclerotherapy is largely unknown. The purpose of this study is to describe a single-institution's incidence of LIC in patients with VMs and coagulopathy-related complications following sclerotherapy.

Design/methods: Retrospective chart review of patients, 0-21 years of age, with VM who underwent sclerotherapy without peri-procedural anticoagulation and had coagulation profiles evaluated within 1 month prior to sclerotherapy.

Data collected: diagnosis type (high vs. low risk for LIC), coagulation profile (including PT/PTT, D-dimer, fibrinogen, and platelet count), sclerosant used, and post-procedure outcomes. Coagulopathy-related complications included clinically relevant bleeding, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Results: N = 138 patients; 59.4% were female. The most common location of VM was the lower extremity (47.8%; 66/138). Of patients with high-risk VMs (29/138 [21%]), 11/29 (37.9%) had laboratory values consistent with LIC, whereas 5% (5/109) of low-risk VMs had LIC. In sum, 492 sclerotherapy procedures were performed with no complications of bleeding, DVT, or PE.

Conclusion: Patients undergoing sclerotherapy for VM with abnormal coagulation profiles may not require peri-procedural low molecular weight heparin (LMWH). Further studies are needed to precisely define which patients would benefit from anticoagulation.

Keywords: hematology; localized intravascular coagulopathy; pediatrics; sclerotherapy; venous malformation.

MeSH terms

Anticoagulants
Blood Coagulation Disorders* / etiology
Blood Coagulation Disorders* / therapy
Female
Heparin, Low-Molecular-Weight
Humans
Male
Pulmonary Embolism*
Retrospective Studies
Sclerotherapy / adverse effects
Vascular Malformations* / therapy

Substances

Anticoagulants
Heparin, Low-Molecular-Weight