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Direct oral anticoagulants and venous malformations: literature review and retrospective study of 29 patients. | LitMetric

AI Article Synopsis

  • Venous malformations (VMs) can cause localized coagulopathy, leading to elevated D-dimer and complications, with low-molecular-weight heparin (LMWH) traditionally used to manage these issues.
  • This study evaluated the effectiveness and safety of direct oral anticoagulants (DOACs) as an alternative to LMWH in treating 29 patients with VMs and coagulopathy from 2013 to 2023.
  • Results indicated that 85% of patients experienced pain relief, 86% had significant D-dimer reduction, and while 37% reported minor bleeding events, the overall safety profile of DOACs shows promise for future use with careful dosing adjustments.

Article Abstract

Background: Venous malformations (VMs) are commonly associated with localized intravascular coagulopathy leading to elevated D-dimer and risks of hemorrhagic and thromboembolic events, particularly in extensive lesions. While low-molecular-weight heparin (LMWH) has been effective in managing coagulopathy and pain, direct oral anticoagulants (DOACs) emerge as a promising alternative.

Objectives: This study aims to evaluate the efficacy and safety of DOACs in treating VMs associated with localized intravascular coagulopathy, offering a comparative perspective to LMWH.

Methods: A retrospective study was conducted on 29 patients with VMs and secondary localized intravascular coagulopathy treated with DOACs between 2013 and 2023 in a single tertiary center specialized in vascular anomalies. Data were collected from February 24, 2023, to September 1, 2023.

Results: Patients' median age was 40 years (range, 22-76 years), with a female predominance of 66%. Descriptive statistical analysis showed that 85% of patients experienced pain improvement, and 86% showed a reduction in D-dimer by at least 25%, with a mean reduction of 57% (SD, ±32%; IQR, [38-81%]). Additionally, 37% of patients reported a bleeding event, mostly minor.

Conclusion: The study findings suggests that DOACs may serve as an alternative to LMWH for patients with VMs associated with pain management and reduced D-dimer, alongside a low observed risk of major bleeding. Tailored dosing considering the location of the malformation, bleeding and thrombotic tendencies, and laboratory abnormalities is recommended. Future studies with larger cohorts and extended follow-up are necessary for more conclusive evidence on DOACs' role in this patient population.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11087699PMC
http://dx.doi.org/10.1016/j.rpth.2024.102400DOI Listing

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