The article presents the results of a study of hemostasis in children with vascular malformations and inflammatory diseases of the maxillofacial region using standard and integrated methods for assessing hemostasis. Objective of the research: to assess the state of the hemostatic system in children with vascular malformations and inflammatory diseases of the maxillofacial region using standart and integrated methods. Materials and methods: on the basis of St. Vladimir's Children's Clinical Hospital in 2015–2019. А prospective open controlled comparative nonrandomized selective study of coagulological status was performed using standard coagulological tests and integral methods for assessing hemostasis (thromboelastography – TEG, thrombodynamics – TD) in 105 patients with lymphatic, lymphovenous, venous, arteriovenous vascular malformations of the head and neck (age 6 [5; 9] years), 47 children with infectious and inflammatory diseases of the maxillofacial area (age 10 [4; 17] years). The control group included 37 children (age 9 [5; 13] years). Results: according to the data, in most patients with vascular malformations, the coagulogram did not reveal pronounced shifts in hemostasis. TEG indices demonstrated hypercoagulability in vascular malformations: the onset time of clot R formation was 11,20 [8,72; 15,75] min (the norm is 9–27 min); clot K formation time was reduced to 3,90 [2,30; 6,02] min (the norm is 2–9 min). According to TD data, the process of fibrin clot growth in patients with vascular malformations accelerated: the clot V growth rate was 32,80 [28,70; 40,20] μm/min (norm 20–29 μm/min), an increase in the rate was observed mainly due to the acceleration of the clot growth initiation. The formation of spontaneous clots was noted in 32% of cases. In the group of infectious and inflammatory diseases of the maxillofacial area, the hypercoagulation was most pronounced: fibrinogen level significantly increased compared with the control group (3,21 [2,69; 4,72] g/l vs 2,69 [2,37; 3,17 ] g/l; p=0,0025). The soluble fibrin monomer complex (SFMC) indicator statistically significantly increased to 5,50 [0,00; 6,00] mg% (1,50 [0,00; 5,00] mg% in the control group, p=0,006). TEG showed a decrease in R (11,10 [8,82; 14,32] min vs 15,2 [11,8; 20,6] min; p=0,001) and K (3,65 [2,45; 5,10] min vs 6,70 [4,20; 8,25] min; p=0,0001), statistically significant compared to the control group. The alpha angle increased to 45,70 [36,20; 56,02] (30,8 [23,25; 41,15] in the control group, p=0,0001); maximum amplitude (MA) and clot density (G) increased in comparison with the control: 56,6±8,68 mm vs 48,10±6,20 mm; p=0,0001 and 6,50 [4,80; 8,00] Kd/sc vs 4,60 [3,60; 5,30] Kd/sc; p=0,0001. The TD indices in patients in this group also reflected a hypercoagulable state: the rate of V clot formation increased to 38,60 [33,00; 51,40] μm/min (30,45 [27,60; 33,30] μm/min in the control group, p<0,0001); the initial rate of clot formation also increased – 63,50 [59,10; 68,62] μm/min (58,74 [56,57; 64,20] μm/min in the control group, p=0,0055); the size (CS) and density (D) of the clot increased – 1425,5 [1265,7; 1505,2] μm (1251,00 [1168,82; 1322,50] μm in the control group, p=0,0029) and 25 362,50 [21 922,00; 29 210,50] conv. units (22 883,00 [20 807,25; 24 658,64] conv. units in the control group, p=0,0208). Spontaneous clots were formed in 50% of cases. Conclusion: integral tests are a sensitive method for assessing the state of hemostasis in patients with vascular malformations and infectious and inflammatory diseases. The revealed hypercoagulable shifts in the form of clot growth rate acceleration work as the basis for a thorough dynamic assessment of the hemostasis system in children with vascular malformations and infectious-inflammatory diseases in order to prevent thrombotic complications.
Successful anesthetic management of a 17-year-old patient with facial arterio-venous undergoing sclerotherapy: a case report
