Dabigatran etexilate in the treatment of localized intravascular coagulopathy associated with venous malformations.
INTRODUCTION
Venous malformations (VM) are congenital slow-flow vascular malformations. A common complication is localized intravascular coagulopathy (LIC), which results from chronic, localized, intraluminal activation and consumption of clotting factors and is characterized by elevated D-dimer and, in severe cases, decreased fibrinogen levels. Therapeutic options include anti-coagulation by Low Molecular Weight Heparin (LMWH) which has been reported to improve pain, decrease thrombosis, improve laboratory parameters and reduce hemorrhagic complications. However, the use of subcutaneous injections of LMWH has several limitations and the indications for therapy remain controversial.


MATERIALS AND METHODS
We present the first small case series of 3 patients with VM-LIC in whom a long-term treatment by dabigatran etexilate, a direct thrombin inhibitor, was initiated in the setting of ambulatory hemostasis consultations.


RESULTS
Clinically, drug tolerance was excellent in all 3 patients. Moderate hemorrhagic complaints occurred in 2 out of 3 patients but there was no thromboembolic event under dabigatran therapy. Dabigatran provided symptomatic relief on pain, swelling and heaviness feeling. Biologically, dabigatran treatment showed various modifications in D-dimers level but the fibrinogen level and platelet count remained unchanged.


CONCLUSION
In conclusion, dabigatran etexilate may provide a viable and more convenient alternative to LMWH in the long-term treatment of VM-LIC. The dose has to be tailored in each patient in function of the bleeding tendency and laboratory hemostasis parameters.
['Binet|Quentin|Q|', 'Lambert|Catherine|C|', 'Hermans|Cedric|C|']
D000328:Adult D000925:Anticoagulants D001778:Blood Coagulation Disorders D001780:Blood Coagulation Tests D000069604:Dabigatran D005260:Female D006801:Humans D054079:Vascular Malformations D055815:Young Adult
Dabigatran Intravascular coagulopathy Vascular malformation Direct oral anticoagulants