Analyzing coagulation dynamics during treatment of vascular malformations with thromboelastography.

Abstract

Slow-flow vascular malformations are abnormal vessels that can lead to activation and consumption of coagulation factors and thrombosis, known as localized intravascular coagulopathy (LIC). Most clinical and research evidence of vascular malformation hemostasis relies on conventional coagulation studies, which may not provide a complete picture. Thromboelastograpy (TEG) is a tool that can provide real-time assessment of a patient's coagulation dynamics, and may allow for a more individualized treatment approach. We hypothesized that patients with slow-flow vascular malformations will have changes in TEG parameters peri-procedure that will help predict blood product or medication administration. Institutional Review Board approved prospective study of patients with slow-flow vascular malformations undergoing a sedated, minor procedure. TEG and conventional coagulation studies were obtained preprocedure, 15min, and when possible, at 30min after the start of the procedure. Twenty-five patients were enrolled. Median age was 15years (range 3-47years). Procedures included laser and/or sclerotherapy. There were no changes in TEG parameters from baseline to 15min or 30min. The following decreased from baseline to 15min: fibrinogen 313 to 287mg/dL (P=.001), D-dimer 1.3 to 1.1mg/L (P=.02), hemoglobin 12.8 to 11.8g/dL (P=.001), and platelet count 272000 to 256000 (P=.006). No patient had a bleeding/thrombotic complication during or within 1week postprocedure. We saw no change in TEG parameters or bleeding or clotting complications despite significant numerical changes in conventional coagulation profiles, suggesting that conventional studies may not be as useful in determining risks of bleeding or thrombotic complications peri-procedure for minor procedures.