Chronic urticaria (CU) patients often present activation of the coagulation cascade and fibrinolysis whose markers correlate with disease severity.
This study evaluated whether CU patients with elevated plasma D-dimer have a poor response to antihistamines, and anticoagulation and inhibition of fibrinolysis may be beneficial in these patients.
68 patients with CU were prescribed cetirizine 10 mg daily for 2 weeks; plasma D-dimer was measured. Patients with persistent uncontrolled CU and elevated D-dimer plasma levels were offered subcutaneous nadroparin 11,400 IU once a day and oral tranexamic acid 1 g three times a day for 2 weeks.
D-dimer levels were elevated in 20.6% patients and were associated with a more severe disease. All patients with elevated D-dimer levels did not respond to antihistamine treatment with cetirizine 10 mg daily and only 1 of these responded satisfactorily to cetirizine 30 mg daily.
8 patients with elevated D-dimer and whose disease was not satisfactorily controlled by prednisone received nadroparin and tranexamic acid. A marked improvement of symptoms was observed in 5/8 cases.
The authors concluded that CU patients with elevated D-dimer often present a more severe disease with reduced response to antihistamines. Based on this short pilot study, some of these patients may benefit from treatment with nadroparin and tranexamic acid.
Asthma is also associated with a procoagulant state in the bronchoalveolar space (Blood, 01/2012).
Heparin and Tranexamic Acid Therapy May Be Effective in Treatment-Resistant Chronic Urticaria with Elevated D-Dimer: A Pilot Study. Int Arch Allergy Immunol. 2010 Mar 4;152(4):384-389. Authors: Asero R, Tedeschi A, Cugno M.