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Periprocedural coagulation and fibrinolytic changes after sclerotherapy for venous malformations

Yingjie Zhu1, Chaonan Wang1, Weixin Wang1

  • 1Department of Hemangioma and Vascular Malformation, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Phlebology
|August 5, 2026
PubMed

PurposeTo prospectively characterize peri-procedural changes in thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), fibrin/fibrinogen degradation products (FDP), D-dimer, thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) in patients with venous malformations (VMs) undergoing percutaneous sclerotherapy.MethodsThis prospective single-center observational study included 68 patients with VMs and 48 healthy controls. Peripheral venous blood was collected 24 h before treatment, immediately after treatment, and on postoperative days 1-3. Local lesional blood was aspirated through the access needle before contrast or sclerosant injection. Biomarker concentrations were compared using paired and repeated-measures analyses. Receiver operating characteristic (ROC) analyses were used only to explore discrimination between VM-associated hemostatic activation and healthy-control values.ResultsLocal lesional samples showed higher TAT, PIC, FDP, and D-dimer concentrations than paired preoperative peripheral samples, whereas TM and t-PAIC did not differ significantly. After sclerotherapy, TAT increased immediately, while D-dimer showed a more prolonged postoperative elevation. At the immediately post-procedure time point, exploratory ROC analysis showed an AUC of 0.9517 for TAT and 0.8931 for D-dimer. The TAT/PIC ratio also increased immediately after treatment, suggesting a transient laboratory shift toward coagulation predominance. No symptomatic venous thromboembolism, pulmonary embolism, overt disseminated intravascular coagulation, or major bleeding was observed during 30-day follow-up.ConclusionIn patients with venous malformations undergoing sclerotherapy, TAT showed an immediate post-procedural increase consistent with acute thrombin generation, whereas D-dimer showed a more sustained postoperative pattern. These findings describe peri-procedural hemostatic activation and support further outcome-based evaluation of TAT and TAT/PIC.

Keywords:
D-dimerfibrinolysislocalized intravascular coagulopathysclerotherapythrombin-antithrombin complexvenous malformation

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