Oxpentifylline treatment of venous ulcers of the leg.

Colgan, Mary Paula; Ja, Dormandy; Jones, P. W.; Schraibman, I. G.; Shanik, D. G.; Young, Richard A.

doi:10.1136/bmj.300.6730.972

Cited by 160 publications

(95 citation statements)

References 14 publications

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“…Several trials have suggested that pentoxifylline may improve venous ulcer healing rates, although the magnitude of the effect appears to be small and its role in patient management is unclear. 66,67 Although the use of other agents such as aspirin and platelet-derived growth factor in promoting the healing or preventing the recurrence of venous ulceration has been reported, there have been no large randomized studies. It also should be mentioned that there are no data to support the use of aspirin in the prevention of thromboembolic events in CVI.…”

Section: Wound and Skin Carementioning

confidence: 99%

Chronic Venous Insufficiency

2005

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C hronic venous disease is often overlooked by primary and cardiovascular care providers because of an underappreciation of the magnitude and impact of the problem. The importance of chronic venous disease is related to the number of people with the disease and the socioeconomic impact of its more severe manifestations. Unfortunately, the literature concerning the prevalence and incidence of chronic venous disease has varied greatly because of differences in the methods of evaluation, criteria for definition, and the geographic regions analyzed. The most common manifestations of chronic venous disease are dilated cutaneous veins, such as telangiectases and reticular veins, and varicose veins. The term chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities with venous hypertension causing various pathologies including pain, swelling, edema, skin changes, and ulcerations. Although the term CVI is often used to exclude uncomplicated varicose veins, varicose veins have incompetent valves with increased venous pressure leading to progressive dilation and tortuosity. We will use the term CVI to represent the full spectrum of manifestations of chronic venous disease.Varicose veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1, although a more recent study supports a higher male prevalence. 1 The Edinburgh Vein Study screened 1566 subjects with duplex ultrasound for reflux finding CVI in 9.4% of men and 6.6% of women, after age adjustment, which rose significantly with age (21.2% in men Ͼ50 years old, and 12.0% in women Ͼ50 years old). 2 The San Valentino Vascular Screening Project found among the 30 000 subjects evaluated by clinical assessment and duplex ultrasound a prevalence of 7% for varicose veins and 0.86% for "symptomatic" CVI. 3 As in previous studies, CVI was more common with increasing age, but there was no significant sex difference. The rate of varicose vein development may be estimated from the Framingham Heart Study, which found an annual incidence of 2.6% in women and 1.9% in men. 4 Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. 5,6 There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. 6,7 Varicose veins have a significant impact on healthcare resources, with millions of people seeking medical attention for their cosmetic appearance annually. Although often minimized, the cosmetic consequences may adversely affect an individual's quality of life and are associated with other manifestations.The more serious consequences of CVI such as venous ulcers have an estimated prevalence of Ϸ0.3%, although active or healed ulcers are seen in Ϸ1% of the adult population. 8 It has been estimated that Ϸ2.5 million people have CVI in the United States, and of those, Ϸ20% develop venous ulcers. 9 The ov...

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Section: Wound and Skin Carementioning

confidence: 99%

Chronic Venous Insufficiency

2005

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“…Franks et al 26 identified three major factors that can delay the healing of an ulcer: the ulcer size, duration before treatment of the ulcer, and limb mobility. Kikta et al 27 found under the ulcer area as a risk factor, whereas Colgan et al 13 found no significant relationships. In none of these studies demonstrated the relationship with age which has been determined as independent prognostic factor for arterial and hypertension 28 although these pathologies associated with the CVI may worsen the prognosis of venous ulcers.…”

Section: Discussionmentioning

confidence: 88%

“…These include studies with pentoxifylline, prostaglandin E 1 , prostacyclin analogs, flavonoids, and ASA. The most rigorous study done with pentoxifylline has been reported by Colgan et al, 13 in which pentoxifylline showed a benefit in healing of venous ulcers, although the work was carried out with small lesions in young patients without the presence of deep vein thrombosis, which, in itself, indicates a favorable prognosis of injuries. Rudofsky conducted a study of venous ulcers where administration of prostaglandin E 1 resulted in an improvement in edema, symptoms, and healing of the lesion, but only 8 of 20 patients in the treated group and 2 of the 22 patients in the control group were able to complete the study.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-seven patients were excluded for the following reasons: presence of diabetes mellitus (n ¼ 3), rheumatoid arthritis (n ¼ 1), peripheral arterial disease (ankleebrachial index: <0.9) (n ¼ 9), or neurological disease (n ¼ 1), or pretreatment with aspirin, oral anticoagulants, or nonsteroidal anti-inflammatory drugs (n ¼ 13). The 51 patients included in the study were randomized into two groups: group treated with ASA (n ¼ 23, 15 patients were C6sEpAs (2)Pr and 8 patients were C6sEsAp (13) Pr) and untreated control group (n ¼ 28, 17 patients were C6sEpAs (2)Pr and 11 patients were C6sEsAp (13) Pr). Table I shows the characteristics of study subjects, and Table II shows the characteristics of ulcerated lesions.…”

Section: Resultsmentioning

confidence: 99%

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Influence of Aspirin Therapy in the Ulcer Associated With Chronic Venous Insufficiency

Solá

Antonio

Fajardo

et al. 2012

Annals of Vascular Surgery

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Background: To determine the effect of aspirin on ulcer healing rate in patients with chronic venous insufficiency, and to establish prognostic factors that influence ulcer evolution. Methods: Between 2001 and 2005, 78 patients with ulcerated lesions of diameter >2 cm and associated with chronic venous insufficiency were evaluated in our hospital. Of these, 51 patients (22 men, 29 women) with mean age of 60 years (range: 36e86) were included in a prospective randomized trial with a parallel control group. The treatment group received 300 mg of aspirin and the control group received no drug treatment; in both groups, healing was associated with standard compression therapy. During follow-up, held weekly in a blinded fashion, there was ulcer healing as well as cases of recurrence. Results were analyzed by intention-to-treat approach. Cure rate was estimated using KaplaneMeir survival analysis, and the influence of prognostic factors was analyzed by applying the Cox proportional hazards model. Results: In the presence of gradual compression therapy, healing occurred more rapidly in patients receiving aspirin versus the control subjects (12 weeks in the treated group vs. 22 weeks in the control group), with a 46% reduction in healing time. The main prognostic factor was estimated initial area of injury (P ¼ 0.032). Age, sex, systemic therapy, and infection showed little relevance to evolution. Conclusions: The administration of aspirin daily dose of 300 mg shortens the healing time of ulcerated lesions in the chronic venous insufficiency (CVI). The main prognostic factor for healing of venous ulcerated lesions is the initial surface area of the ulcer.

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“…18 This therapy has been examined in a randomized multicentre clinical trial in which patients with venous ulcers which had shown no signs of healing following at least two months routine outpatient treatment were started on oxpentifylline or identical placebo tablets. 19 By six months, significantly more healed ulcers were reported with oxpentifylline 400mg three times daily compared to a placebo group. It is suggested that this result may have been achieved by the advantageous effects of oxypentifylline on white cell adhesiveness, red cell deformability and hence oxygen delivery to the tissues.…”

Section: Drug Therapymentioning

confidence: 99%