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.