Impact of Anticoagulation on Quality of Life in Patients with Slow-Flow Vascular Malformations Open Access

• Anticoagulation improved quality of life, pain, and D-dimer levels in patients with slow-flow vascular malformations.

• Minor bleeding events, particularly heavy menstrual bleeding, occurred in 24% of patients, highlighting the importance of monitoring.

Pain from slow-flow vascular malformations is common, attributed to localized intravascular coagulopathy and has a negative impact on quality of life (QOL). The use of anticoagulation has been anecdotal. The objective of this study was to determine the impact of anticoagulation in slow-flow vascular malformations on QOL, pain, and/or laboratory markers of LIC. A multi-institutional, prospective, nonrandomized IRB approved observational study enrolled subjects with slow-flow vascular malformations -related pain for whom anticoagulation was prescribed. Patient assessments (history, Peds QL survey, laboratory data) occurred at study entry, 2 weeks, 4 weeks and 12 weeks (optional) after starting anticoagulation. Forty-five subjects were enrolled, with a median age of 18 years (range 5-59). The cohort consisted of 14 males (31.1%) and 31 females (68.9%). All patients were naïve to anticoagulation, prescribed low-molecular weight heparin (n=2), rivaroxaban (n=40) or apixaban (n=3). Six (13%) patients were on sirolimus and two on daily aspirin prior to starting anticoagulation. Eleven (24%) patients experienced minor bleeding events, including 6 with heavy menstrual bleeding. Two patients experienced clinically relevant non-major bleeding (CRNMB) leading to cessation of anticoagulation. D-dimer and pain scores decreased, and QOL survey scores increased, with all changes being statistically significant from baseline to 2 and 4 weeks. Patients with slow-flow vascular malformations had less pain and improved QOL scores and coagulation parameters when treated with anticoagulation. Non-major bleeding occurred, especially menorrhagia, in approximately 24% of patients, demonstrating the need to monitor and balance risks against benefits.