Coagulation abnormalities in pediatric and adult patients after sclerotherapy or embolization of vascular anomalies

OBJECTIVE. The purpose of our study was to examine the coagulation status i n patients with vascular anomalies who had undergone sclerotherapy or embol ization. SUBJECTS AND METHODS: Ours was a prospective pilot study of 29 patients who had undergone sclerotherapy or embolization of large vascular anomalies. F ibrinogen, 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 level s 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 evid enced by a decrease in platelets and fibrinogen, an increase in prothrombin time, and a conversion from negative to positive d-dimers. In contrast, sc lerotherapy or embolization with cyanoacrylic, polyvinyl alcohol foam parti cles, or platinum microcoils was not associated with coagulation disturbanc es. CONCLUSION. The coagulation disturbances that occur in response to dehydrat ed alcohol or sodium tetradecyl sulfate sclerotherapy or embolizatiion coul d compromise the patient's clotting ability. Patients who :receive dehydrat ed alcohol or sodium tetradecyl sulfate during a preoperative sclerotherapy or embolization may experience coagulation disturbances that could increas e the risk of bleeding, thrombosis, or hematoma. This patient population ma y benefit from the use of glue, foam, or coils as a substitute for dehydrat ed alcohol or sodium tetradecyl sulfate.