How we approach coagulopathy with vascular anomalies

Abstract

Some vascular anomalies can present with challenging hematologic aberrations.Kaposiform hemangioendothelioma (KHE) may be complicated with Kasabach-Merritt phenomenon (KMP) and stagnant blood flow in slow-flow malformations can promote activation and consumption of coagulation factors, which results in bleeding and clotting known as localized intravascular coagulopathy (LIC). These patients can experience significant morbidity secondary to pain due to thrombosis and are at higher risk of hematologic complications during surgical procedures. No standard of care has been established to prevent or manage these complications. This review focuses on the management of coagulopathy in children and adults with vascular anomalies.

Anticoagulation and vascular anomalies

“…Laser procedures and sclerotherapy procedures on venous malformations that are isolated or that drain into normal veins are likely less risky than those on malformations that drain into dysplastic veins or on venous ectasia [ 4 , 29 ]. The role of perioperative LIC in VTE risk is debated, especially if only D-dimer is elevated [ 4 , 15 , 24 , [30] , [31] , [32] ], but algorithms have been suggested to try to reduce perioperative risk [ 14 , 33 ].…”

Introduction: The changing role of the pediatric hematologist/oncologist in the care of people with vascular anomalies

“…The articles use cases to illustrate approaches and summarize overviews. This supplement provides several articles that discuss general approaches to suspected vascular lesions, vascular tumors (including hemangiomas), and management strategies for localized lesions 1‐5 …”

“…This supplement provides several articles that discuss general approaches to suspected vascular lesions, vascular tumors (including hemangiomas), and management strategies for localized lesions. [1][2][3][4][5] There are some challenging conditions associated with vascular anomalies that require integration with other disciplines. Complex chylous effusions require multimodal approach and coagulopathies can be presenting symptoms.…”