Rivaroxaban for the treatment of consumptive coagulopathy associated with a vascular malformation

Vandenbriele, Christophe; Vanassche, Thomas; Peetermans, Marijke; Verhamme, Peter; Peerlinck, Kathelijne

doi:10.1007/s11239-013-1024-7

Cited by 30 publications

(24 citation statements)

References 14 publications

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“…There are case reports of oral anti‐Xa agents being used for severe LIC in adults . The use of an oral agent avoids the need for injections and is thus appealing for children.…”

Section: Introductionmentioning

confidence: 99%

Localised intravascular coagulation complicating venous malformations in children: Associations and therapeutic options

Zhuo

Russell

Wargon

et al. 2017

J Paediatrics Child Health

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Venous malformations are slow-flow congenital vascular malformations that enlarge as the child ages and may be associated with localised intravascular coagulation, a consumptive coagulopathy characterised by elevated D-dimer and decreased fibrinogen levels. The authors review the known correlations between localised intravascular coagulation and venous malformation number, size and planes involved, and call attention to the concept of the progression of localised intravascular coagulopathy as the child ages and their venous malformations enlarge. The authors also discuss the identified therapeutic options for its investigation, management and treatment, including compression garments, anti-coagulation therapy, sclerotherapy, endovascular laser, surgical excision and sirolimus (rapamycin). Evidence for protocol improvements that may be instigated for the optimal physical and medical therapy of venous malformations complicated by localised intravascular coagulopathy is reviewed.

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“…There are case reports of oral anti‐Xa agents being used for severe LIC in adults . The use of an oral agent avoids the need for injections and is thus appealing for children.…”

Section: Introductionmentioning

confidence: 99%

Localised intravascular coagulation complicating venous malformations in children: Associations and therapeutic options

Zhuo

Russell

Wargon

et al. 2017

J Paediatrics Child Health

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“…So far there has been a single report of the successful use of a direct anti-Xa inhibitor in a patient with venous malformations [12]. To the best of our knowledge, this is the first report of the use of dabigatran etexilate and the first comparison of a prolonged treatment with an LMWH and a direct oral anticoagulant in this setting.…”

Section: Discussionmentioning

confidence: 80%

Dabigatran etexilate versus low-molecular weight heparin to control consumptive coagulopathy secondary to diffuse venous vascular malformations

Ardillon

Lambert

Eeckhoudt

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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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.

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“…Vandenbriele et al described the case of a 30-year-old man with massive venous malformation involving the right arm, shoulder, and right side of the trunk, who was investigated for a tendency of easy bruising and prolonged bleeding after traumas, which gradually worsened over time and finally lead to subarachnoid intracranial bleeding. 21 Laboratory data were compatible with a diagnosis of compensated chronic DIC, probably attributable to the venous malformation. The initial patient management consisted of LMWH prophylaxis (40 mg of enoxaparin once daily), which was then shifted to rivaroxaban 10 mg once daily for long-term treatment.…”

Section: Rivaroxabanmentioning

confidence: 73%

Direct Oral Anticoagulants for Disseminated Intravascular Coagulation: An Alliterative Wordplay or Potentially Valuable Therapeutic Interventions?

Lippi

Favaloro

2019

Semin Thromb Hemost

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Disseminated intravascular coagulation (DIC) is a relatively rare but life-threatening condition, the outcome of which depends largely on timely and accurate therapeutic management. Inhibiting the activation of blood coagulation is an effective option for limiting the burden of diffuse intravascular thrombosis for attenuating consumption of clotting factors and platelets and ultimately preventing massive bleeding. Direct oral anticoagulants (DOACs) are a relatively new generation of drugs that specifically inhibit activated factors II (thrombin) and X, thus providing effective anticoagulation while concomitantly limiting the hemorrhagic risk compared with other conventional anticoagulant agents. The peculiar mechanism of action would hence at least theoretically support their usage in patients with DIC, especially in those with a more pronounced thrombotic phenotype. A comprehensive literature search on the use of DOACs in patients with intravascular coagulopathies currently yielded only 15 documents, all case reports, totaling 21 patients (dabigatran, n = 5; rivaroxaban, n = 13; apixaban, n = 3; edoxaban, n = 0). Taken together, the current literature data suggest that these drugs may have low prophylaxis efficacy and thereby their indication for preventing DIC in high-risk patients may be limited. Nevertheless, DOACs seem at least therapeutically equivalent to heparin in some forms of DIC, especially in those with prevalent thrombotic phenotype, while having more favorable oral administration. The inherent risk of hemorrhages from heparin injection is also shared by DOACs; therefore, their use in DIC patients with a prevalent bleeding phenotype will probably remain unwarranted. Major caution should also be used in patients with impaired drug metabolism, especially those progressing toward liver or renal failure or receiving aggressive antimicrobial treatment. Where potentially indicated, further clinical trials should be planned to test the therapeutic efficacy of these drugs in patients with different types or forms of DIC.

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Rivaroxaban for the treatment of consumptive coagulopathy associated with a vascular malformation

Cited by 30 publications

References 14 publications

Localised intravascular coagulation complicating venous malformations in children: Associations and therapeutic options

Localised intravascular coagulation complicating venous malformations in children: Associations and therapeutic options

Dabigatran etexilate versus low-molecular weight heparin to control consumptive coagulopathy secondary to diffuse venous vascular malformations

Direct Oral Anticoagulants for Disseminated Intravascular Coagulation: An Alliterative Wordplay or Potentially Valuable Therapeutic Interventions?

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