Association of localized intravascular coagulopathy with venous malformations
| Autor: | M.-T. Barrellier, Pascal Thibon, Anne Dompmartin, Romain Vanwijck, Ben Pocock, Cédric Hermans, Laurence M. Boon, Aurélie Acher, Miikka Vikkula, Daniel Labbé, Véronique Deneys, Agnès Lequerrec, Sébastien Tourbach |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.drug_class Vascular Malformations Low molecular weight heparin Dermatology Severity of Illness Index Article Fibrin Fibrinogen Degradation Products Phlebolith Sex Factors Belgium Risk Factors Coagulopathy Medicine Humans Decompensation Prospective Studies Child Aged Pain Measurement Ultrasonography Disseminated intravascular coagulation Univariate analysis business.industry Vascular disease Infant General Medicine Blood Coagulation Disorders Middle Aged medicine.disease Thrombosis Surgery Child Preschool Female Radiology France business |
| Zdroj: | Archives of dermatology. 144(7) |
| ISSN: | 1538-3652 |
| Popis: | OBJECTIVE: To determine which venous malformations (VMs) are at risk for coagulopathy. Venous malformations are slow-flow vascular malformations present at birth, and localized intravascular coagulopathy (LIC) causes pain and thrombosis within a lesion and severe bleeding during surgical procedures. DESIGN: Prospective convenience sample accrued from 2 multidisciplinary sites in Brussels, Belgium, and Caen, France. PARTICIPANTS: The study population comprised 140 patients with clinical data and coagulation parameters. Magnetic resonance imaging was performed for 110 patients. MAIN OUTCOME MEASURE: Measurement of D-dimer levels. RESULTS: Of the 140 participants, 59 (42%) showed high D-dimer levels, 36 (61%) of whom had levels higher than 1.0 microg/mL. Six of the participants had low fibrinogen levels. In univariate analysis, large surface, presence of palpable phleboliths, and truncal localization were associated with high D-dimer levels. In the multivariate analysis, only large surface area and presence of phleboliths remained independently associated with high D-dimer levels. Severe LIC, characterized by concomitant low fibrinogen level, was associated with extensive venous malformations of the extremities. CONCLUSIONS: Localized intravascular coagulopathy is statistically significantly associated with large and/or deep venous malformations that affect any location, which can have a palpable phlebolith. These patients are at risk of local pain due to thrombosis. Lesions with elevated D-dimer levels associated with low fibrinogen levels (severe LIC) commonly affect an extremity and have a high risk of hemorrhage. Low-molecular-weight heparin can be used both to treat the pain caused by LIC and to prevent decompensation of severe LIC to disseminated intravascular coagulopathy. |
| Databáze: | OpenAIRE |
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