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Venous malformation with localized intravascular coagulopathy in children treated with sclerotherapy and LWMH

Xiao Gao1, Xuming Wang1, Yuhua Wei1

  • 1Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

Frontiers in Pediatrics
|July 16, 2026
PubMed

Insights

Localized intravascular coagulopathy (LIC) in pediatric venous malformations (VMs) is common and linked to lesion size, not demographics. Sclerotherapy is key for management, with heparin as an adjunct.

Area of Science:

  • Pediatric Hematology
  • Vascular Anomalies
  • Coagulation Disorders

Background:

  • Localized intravascular coagulopathy (LIC) is an underrecognized complication of pediatric venous malformations (VMs).
  • Chronic thrombogenic activation within VM lesions drives LIC, potentially worsened by developmental hemostatic traits in children.
  • Clinical characteristics and management of pediatric LIC are not well-defined.

Purpose of the Study:

  • To investigate factors associated with the occurrence and severity of LIC in pediatric patients with VMs.
  • To evaluate the effectiveness of sclerotherapy and adjunct therapies in managing LIC.
  • To provide evidence for optimizing clinical management strategies for pediatric LIC.

Main Methods:

  • Retrospective cohort study of 116 pediatric VM patients undergoing sclerotherapy.
  • LIC defined as D-dimer ≥0.60 μg/ml.
  • Statistical analyses included Chi-square, Fisher's exact, Mann-Whitney U tests, and correlation analysis.

Main Results:

  • 51% of patients had LIC (38 mild, 11 moderate, 2 severe).
  • LIC occurrence/severity was not associated with sex, age, or location.
  • Severe LIC occurred in extensive VMs (≥2 joint planes); sclerotherapy with LMWH rapidly corrected coagulopathy.

Conclusions:

  • LIC occurrence in pediatric VMs is independent of demographic/anatomic factors; severity correlates with lesion burden.
  • Sclerotherapy is the primary intervention for LIC, with LMWH as perioperative adjuvant therapy.
  • Routine screening for occult VMs in unexplained pediatric coagulopathy is recommended.
Abstract

Keywords:
LWMHcoagulationlocalized intravascular coagulopathysclerotherapyvenous malformations (VM)

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