title: Heparin and tranexamic Acid therapy may be effective in treatment-resistant chronic urticaria with elevated d-dimer: a pilot study.
abstract: BACKGROUND
  Chronic urticaria (CU) patients often present activation of the coagulation cascade and fibrinolysis whose markers correlate with disease severity.
  
  
  OBJECTIVE
  We evaluated whether CU patients with elevated plasma D-dimer have a poor response to antihistamines, and anticoagulation and inhibition of fibrinolysis may be beneficial in these patients.
  
  
  METHODS
  Sixty-eight consecutive patients with CU were prescribed cetirizine 10 mg daily for 2 weeks; plasma D-dimer was measured. Non-responders were given cetirizine 30 mg daily for 1 week and subsequently, in case of failure, systemic steroids. Patients with persistent uncontrolled CU and elevated D-dimer plasma levels were offered subcutaneous nadroparin 11,400 IU once a day and oral tranexamic acid 1 g three times a day for 2 weeks.
  
  
  RESULTS
  D-dimer levels were elevated in 14/68 (20.6%) patients (range 306-7,317 ng/ml; normal values <278 ng/ml) and were associated with a more severe disease. Twelve of 14 patients with elevated D-dimer levels did not respond to antihistamine treatment (p = 0.0001). On the whole, 14 patients reported a poor or absent response to cetirizine 10 mg daily and only 1 of these responded satisfactorily to cetirizine 30 mg daily. Eight patients with elevated D-dimer and whose disease was not satisfactorily controlled by prednisone received nadroparin and tranexamic acid. A marked improvement of symptoms was observed in 5/8 cases.
  
  
  CONCLUSIONS
  Our findings indicate that CU patients with elevated D-dimer often present a more severe disease with reduced response to antihistamines. Based on this short pilot study, some of these patients may benefit from treatment with nadroparin and tranexamic acid.
authors.affiliation: Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italia. r.asero@libero.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Asero
authors.forename: Alberto
authors.initials: A
authors.lastname: Tedeschi
authors.forename: Massimo
authors.initials: M
authors.lastname: Cugno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017332:Cetirizine / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease; D018450:Disease Progression; D004351:Drug Resistance; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D039563:Histamine H1 Antagonists, Non-Sedating / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D017211:Treatment Failure; D014581:Urticaria / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; D039563:Histamine H1 Antagonists, Non-Sedating; D017762:Nadroparin; C036309:fibrin fragment D; D014148:Tranexamic Acid; D017332:Cetirizine