Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Arkansas Children's Hospital, Little Rock, Arkansas.
Pediatr Blood Cancer. 2021 Feb;68(2):e28824. doi: 10.1002/pbc.28824. Epub 2020 Nov 19.
BACKGROUND/OBJECTIVES: 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.
DESIGN/METHODS: 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, 15 min, and when possible, at 30 min after the start of the procedure.
Twenty-five patients were enrolled. Median age was 15 years (range 3-47 years). Procedures included laser and/or sclerotherapy. There were no changes in TEG parameters from baseline to 15 min or 30 min. The following decreased from baseline to 15 min: fibrinogen 313 to 287 mg/dL (P = .001), D-dimer 1.3 to 1.1 mg/L (P = .02), hemoglobin 12.8 to 11.8 g/dL (P = .001), and platelet count 272 000 to 256 000 (P = .006). No patient had a bleeding/thrombotic complication during or within 1 week 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.
背景/目的：慢血流血管畸形是异常血管，可导致凝血因子的激活和消耗以及血栓形成，称为局部血管内凝血（LIC）。血管畸形止血的大多数临床和研究证据依赖于常规凝血研究，但这些研究可能无法提供完整的情况。血栓弹性描记术（TEG）是一种可以实时评估患者凝血动力学的工具，并且可能允许采用更个体化的治疗方法。我们假设慢血流血管畸形患者在手术期间的 TEG 参数会发生变化，这有助于预测血液制品或药物的使用。
设计/方法：对接受镇静性小手术的慢血流血管畸形患者进行机构审查委员会批准的前瞻性研究。在术前、15 分钟和手术开始后 30 分钟（如果可能的话）时获取 TEG 和常规凝血研究。
共纳入 25 例患者。中位年龄为 15 岁（范围 3-47 岁）。手术包括激光和/或硬化疗法。从基线到 15 分钟或 30 分钟时，TEG 参数没有变化。从基线到 15 分钟时，以下指标降低：纤维蛋白原从 313 降至 287mg/dL（P=.001），D-二聚体从 1.3 降至 1.1mg/L（P=.02），血红蛋白从 12.8 降至 11.8g/dL（P=.001），血小板计数从 272000 降至 256000（P=.006）。没有患者在手术期间或手术后 1 周内出现出血/血栓并发症。
尽管常规凝血谱有明显的数值变化，但我们没有看到 TEG 参数或出血或血栓并发症的变化，这表明常规研究可能无法在确定小手术期间出血或血栓并发症风险方面提供帮助。
