Pediatric Clinics of North America - CIPERJ

350 ADAMS & WENTZEL
Fig. 7. VM: risk for coagulopathy.
a severity scoring system (a point was given to each involved site) and found
that higher VM severity scores were associated with more severe LIC. In this
retrospective review, the use of graded permanent elastic compression and
low-molecular-weight heparin (LMWH) was effective preventive treatment
causing a decrease in pain and phlebolith formation.
At Cincinnati Children’s Hospital Medical Center, the authors analyzed
58 patients who had vascular malformations and found a significantly increased
risk for coagulopathy in VMs, VLMs, and CVLMs with a diffuse
or multifocal presentation. Elevation in the D-dimer was the most common
hematologic abnormality. Coagulopathy seemed associated with increased
pain in these patients [53].
Finally, there are reports in the literature regarding the risks for coagulopathy
during interventional radiologic procedures [54]. Mason and colleagues
analyzed coagulation abnormalities in patients undergoing sclerotherapy and
embolization for vascular anomalies. An increased incidence of coagulopathy
can occur during injection with dehydrated alcohol or sodium tetradecyl
sulfate. Coagulopathy consisted of a decrease in platelets and fibrinogen, an
increase in prothrombin time, and a conversion from negative to positive
D-dimers.
Thrombophilic predisposition
Several congenital or acquired thrombophilic conditions have been identified
in the general population as risk factors for venous thromboembolism