Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 3;8(3):102402.
doi: 10.1016/j.rpth.2024.102402. eCollection 2024 Mar.

Anticoagulation and vascular anomalies

Affiliations

Anticoagulation and vascular anomalies

Shelley E Crary et al. Res Pract Thromb Haemost. .

Abstract

A State of the Art lecture titled "Anticoagulation and Vascular Anomalies" was presented at the International Society on Thrombosis and Haemostasis (ISTH) Congress in 2023. Vascular anomalies have been classified by the International Society for the Study of Vascular Anomalies into vascular tumors and vascular malformations. Although some vascular tumors, such as tufted angioma and kaposiform hemangioendothelioma, and other vascular malformations can present with coagulation aberrancies, these are not generally managed with anticoagulation. A subclassification of vascular malformations includes slow-flow vascular malformations. It is this subgroup specifically that has a high risk of venous thromboembolism (VTE) and morbidity associated with coagulopathy that may be present. In these select cases, anticoagulation may be indicated to reduce the risk of VTE, treat VTE, or manage localized thrombosis in the malformation that causes significant pain and reduced quality of life. There are established risk factors for VTE in these patients that will be reviewed. Finally, we summarize relevant new data on this topic presented during the 2023 ISTH Congress.

Keywords: anticoagulant; coagulopathy; sclerotherapy; vascular malformation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient with extensive multifocal venous malformation of his torso due to somatic TEK mutation. He has severe localized intravascular coagulopathy with hypofibrinogenemia, elevated D-dimer, and mild thrombocytopenia that has responded well to chronic anticoagulation with enoxaparin initially and, now, rivaroxaban.
Figure 2
Figure 2
Clinical photographs (black arrows) and magnetic resonance imaging (white arrows) of lateral marginal vein in a child with PIK3CA-related overgrowth syndrome. The patient has subsequently undergone several sclerotherapy procedures to ensure closure of the aberrant vein.
Figure 3
Figure 3
Proposed periprocedural management of localized intravascular coagulopathy to reduce risk of venous thromboembolism (VTE). aPTT, activated partial thromboplastin time; CBC, complete blood count; LMWH, low-molecular-weight heparin; PT, prothrombin time.

References

    1. International Society for the Study of Vascular Anomalies ISSVA Classification of Vascular Anomalies. 2018. http://www.issva.org/classification
    1. Ji Y., Yang K., Peng S., Chen S., Xiang B., Xu Z., et al. Kaposiform haemangioendothelioma: clinical features, complications and risk factors for Kasabach-Merritt phenomenon. Br J Dermatol. 2018;179:457–463. - PMC - PubMed
    1. Croteau S.E., Kozakewich H.P., Perez-Atayde A.R., Fishman S.J., Alomari A.I., Chaudry G., et al. Kaposiform lymphangiomatosis: a distinct aggressive lymphatic anomaly. J Pediatr. 2014;164:383–388. - PMC - PubMed
    1. Ricci K.W., Chute C., Hammill A.M., Dasgupta R., Patel M. Retrospective study of hematologic complications in patients with slow-flow vascular malformations undergoing sclerotherapy. Pediatr Blood Cancer. 2020;67 doi: 10.1002/pbc.28277. - DOI - PubMed
    1. Mack J.M., Verkamp B., Richter G.T., Nicholas R., Stewart K., Crary S.E. Effect of sirolimus on coagulopathy of slow-flow vascular malformations. Pediatr Blood Cancer. 2019;66 doi: 10.1002/pbc.27896. - DOI - PubMed

LinkOut - more resources