Risk stratification
Prior to procedures, patients with extensive slow-flow vascular
malformations should be evaluated by a hematologist. Laboratory values
obtained should include: PT, aPTT, CBC, fibrinogen and d-dimer. Patients
with significant elevation of d-dimer (>5 times ULN) and
hypofibrinogenemia (<100 mg/dl) or thrombocytopenia will
likely benefit from anticoagulation7,9,10,26,47. The
risk appears to be higher with more invasive procedures such as excision
or extensive sclerotherapy48. If only d-dimer is
elevated but venous ectasia is present, the patient may also be at risk
of VTE following the procedure and the management must be individualized
and compression garments at minimum may be utilized.