Heparin and tranexamic Acid therapy may be effective in treatment-resistant chronic urticaria with elevated d-dimer: a pilot study.
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.
Asero
Riccardo
R
Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italia. r.asero@libero.it
Tedeschi
Alberto
A
Cugno
Massimo
M
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
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