Periprocedural coagulation and fibrinolytic changes after sclerotherapy for venous malformations
Yingjie Zhu, Chaonan Wang, Weixin Wang, Fengli Jiang, Yanze Lv, Hechen Jia, Xiaonan YangPurpose
To prospectively characterize peri-procedural changes in thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), fibrin/fibrinogen degradation products (FDP), D-dimer, thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) in patients with venous malformations (VMs) undergoing percutaneous sclerotherapy.
Methods
This prospective single-center observational study included 68 patients with VMs and 48 healthy controls. Peripheral venous blood was collected 24 h before treatment, immediately after treatment, and on postoperative days 1–3. Local lesional blood was aspirated through the access needle before contrast or sclerosant injection. Biomarker concentrations were compared using paired and repeated-measures analyses. Receiver operating characteristic (ROC) analyses were used only to explore discrimination between VM-associated hemostatic activation and healthy-control values.
Results
Local lesional samples showed higher TAT, PIC, FDP, and D-dimer concentrations than paired preoperative peripheral samples, whereas TM and t-PAIC did not differ significantly. After sclerotherapy, TAT increased immediately, while D-dimer showed a more prolonged postoperative elevation. At the immediately post-procedure time point, exploratory ROC analysis showed an AUC of 0.9517 for TAT and 0.8931 for D-dimer. The TAT/PIC ratio also increased immediately after treatment, suggesting a transient laboratory shift toward coagulation predominance. No symptomatic venous thromboembolism, pulmonary embolism, overt disseminated intravascular coagulation, or major bleeding was observed during 30-day follow-up.
Conclusion
In patients with venous malformations undergoing sclerotherapy, TAT showed an immediate post-procedural increase consistent with acute thrombin generation, whereas D-dimer showed a more sustained postoperative pattern. These findings describe peri-procedural hemostatic activation and support further outcome-based evaluation of TAT and TAT/PIC.