Dabigatran etexilate versus low-molecular weight heparin to control consumptive coagulopathy secondary to diffuse venous vascular malformations.
Diffuse venous malformations can be associated with a consumptive coagulopathy characterized by a reduction of fibrinogen level, platelet count and elevated D-dimer level. We report a case of a patient with extensive venous malformations, hemorrhagic symptoms and biological signs of intravascular coagulopathy. She was initially treated effectively with low-molecular weight heparin (LMWH) (enoxaparin 1 mg/kg, bid) and switched to low-dose dabigatran etexilate (110 mg bid) for more than 2 years. Both treatments showed a similar clinical efficacy with the absence of bleeding or thrombotic complications. Compared with LMWH, dabigatran etexilate provided a similar correction of the fibrinogen level and platelet count but was less effective to reduce the D-dimer level. Although dabigatran etexilate can be safely used to control the consumptive coagulopathy secondary to venous malformation and provides a practical alternative to LMWH, its efficacy in vivo at a low dose to reduce the D-dimer level was lower than that of LMWH.
aHaematology-Haemostasis Unit, University Hospital, Tours, France bHaemostasis and Thrombosis Unit, Haemophilia Clinic, Division of Haematology cHaemostasis Laboratory, Department of Biological Chemistry dDivision of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Clinic of the Saint-Luc University Hospital, Catholic University of Leuven, Brussels, Belgium.
Laurent
L
Ardillon
Catherine
C
Lambert
Stéphane
S
Eeckhoudt
Laurence M
LM
Boon
Cedric
C
Hermans
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001792:Blood Platelets / Q000378:metabolism / Q000473:pathology; D000069604:Dabigatran / Q000627:therapeutic use*; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D010976:Platelet Count; D013927:Thrombosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D054079:Vascular Malformations / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D000925:Anticoagulants; D017984:Enoxaparin; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen; D000069604:Dabigatran