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Coagulation Abnormalities in Pediatric and Adult Patients After Sclerotherapy or Embolization of Vascular Anomalies

¹ Department of Anesthesia, Children's Hospital, 300 Longwood Ave., Boston, MA 02115-5737.
² Department of Radiology, Children's Hospital, Boston, MA 02115-5737.
³ Department of Hematology-Oncology, Children's Hospital, Boston, MA 02115-5737.
⁴ Department of Biostatistics, Children's Hospital, Boston, MA 02115-5737.

OBJECTIVE. The purpose of our study was to examine the coagulation status in patients with vascular anomalies who had undergone sclerotherapy or embolization.

SUBJECTS AND METHODS. Ours was a prospective pilot study of 29 patients who had undergone sclerotherapy or embolization of large vascular anomalies. Fibrinogen, platelet, and d-dimer levels and prothrombin time were obtained before, immediately after, and on the day after the procedure.

RESULTS. Five patients with venous malformations had positive d-dimer levels before the procedure. A subgroup analysis revealed a relationship between the type of agent used and the change in coagulation status. Specifically, a positive relationship was found between the use of dehydrated alcohol or sodium tetradecyl sulfate and a disruption in coagulation profiles as evidenced by a decrease in platelets and fibrinogen, an increase in prothrombin time, and a conversion from negative to positive d-dimers. In contrast, sclerotherapy or embolization with cyanoacrylic, polyvinyl alcohol foam particles, or platinum microcoils was not associated with coagulation disturbances.

CONCLUSION. The coagulation disturbances that occur in response to dehydrated alcohol or sodium tetradecyl sulfate sclerotherapy or embolization could compromise the patient's clotting ability. Patients who receive dehydrated alcohol or sodium tetradecyl sulfate during a preoperative sclerotherapy or embolization may experience coagulation disturbances that could increase the risk of bleeding, thrombosis, or hematoma. This patient population may benefit from the use of glue, foam, or coils as a substitute for dehydrated alcohol or sodium tetradecyl sulfate.

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