Peri-procedural Anticoagulation in Patients with Head and Neck Versus Extremity Venous Malformations.
Peri-procedural Anticoagulation in Patients with Head and Neck Versus Extremity Venous Malformations.
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DOI：
10.1002/lary.29123
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Padia R
中科院分区：
文献类型：
--
作者：
Dharmarajan H;McCoy JL;Jabbour N;McCormick A;Xavier F;Correa D;Padia R
(1)回顾多学科血管异常中心关于静脉畸形（VM）围手术期抗凝治疗的实践，以及相关的血栓栓塞和弥散性血管内凝血（DIC）事件的风险。(2)比较头颈部（H&N）和四肢VM患者血栓栓塞事件和DIC术后风险。经机构审查委员会（IRB）批准，对120例VM患者进行回顾性图表审查。血栓栓塞事件被定义为硬化治疗后或手术后2个月内远处或局部静脉结构未直接处理的血栓形成。39例涉及H&N， 81例基于四肢。肢体VM组术后血栓形成8例（8/71;11.3%），而H&N组术后血栓形成0例（OR: 0, 95% CI .00 -）。09), p = 0.049。d -二聚体升高组（H&N: 0%，四肢：22.7%,5/22）与d -二聚体正常组（H&N: 0%，四肢：6.3% [1/16],P = 0.370）术后血栓栓塞事件发生率无差异。术后接受围术期抗凝治疗的患者（H&N: 0%，肢体：21%，4/19）与未接受围术期抗凝治疗的患者（H&N: 0%，肢体：8.2%,4/49）（肢体：OR: 3.00, 0.67 - 13.50, P = 0.206）术后血栓栓塞事件发生率无差异。术后血栓栓塞是罕见的治疗静脉畸形，特别是在头颈部亚部位。无论抗凝使用，H&N VM患者没有血栓栓塞事件。这样的事件很少发生，而且几率可能接近于零，尤其是在样本量小的情况下。
(1) Review a multidisciplinary vascular anomalies center’s practice regarding peri-procedural anticoagulation for venous malformations (VM) and the associated risk of thromboembolic and disseminated intravascular coagulation (DIC) events. (2) Compare the risk of thromboembolic events and DIC post-procedure between head and neck (H&N) and extremity VM patients. An Institutional Review Board (IRB)-approved, retrospective chart review was performed on 120 VM patients. A thromboembolic event was defined as a thrombus formation post-sclerotherapy or post-surgery within 2 months in a distant or local venous structure not directly addressed by the procedure. There were 39 cases involving the H&N and 81 cases based at the extremities. There were eight cases of post-procedure thrombus formation within the extremity VM group (8/71; 11.3%) as opposed to 0 cases in the H&N group (OR: 0, 95% CI .00–.09), p = .049. There was no difference in incidence of post-procedure thromboembolic events between those with elevated D-dimer (H&N: 0%, extremity: 22.7%, 5/22) and normal D-dimer values (H&N: 0%, extremity: 6.3% [1/16], P = .370). There was no difference in incidence of post-procedure thromboembolic events between those who received peri-procedural anticoagulation (H&N: 0%, extremity: 21%, 4/19) and those who did not (H&N: 0%, extremity: 8.2%, 4/49), (Extremity: OR: 3.00, .67–13.50, P = .206). Post-procedure thromboembolism is rare in the treatment of venous malformations, especially in the head and neck subsite. Regardless of anticoagulation use, there were no thromboembolic events for H&N VM patients. Such events are rare, and the odds may approach zero, especially with small sample size.
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