Three-Month Therapy with Calcium-Heparin in Comparison with Ticlopidine in Patients with Peripheral Arterial Occlusive Disease at Leriche-Fontaine IIb Class

Andreozzi, Giuseppe Maria; Signorelli, Salvatore Santo; Cacciaguerra, Giuseppe; Pino, Luigi Di; Martini, Romeo; Monaco, Sergio; Butto, Giuseppe; Sardina, Marco

doi:10.1177/000331979304400407

Cited by 12 publications

(4 citation statements)

References 8 publications

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“…17 A 3-month course of unfractionated heparin (12,500 IU once daily) has also been shown to improve pain-free walking distances to a greater extent than an antiplatelet agent, ticlopidine, alone 16 in patients with PAOD. This study provides supporting evidence for the use of low-dose heparin in patients with PAOD.…”

Section: Discussionmentioning

confidence: 99%

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Endogenous heparin activity is decreased in peripheral arterial occlusive disease

Shankar

Handa

Hands

2008

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

“…16,17 We hypothesized that part of the heightened coagulation activity in atherosclerotic disease relates to the reduced production of endogenous heparinlike substances in these patients. We therefore set out to measure endogenous heparin-like activity in patients with PAOD and to identify its relationship to the severity of disease.…”

mentioning

confidence: 99%

Endogenous heparin activity is decreased in peripheral arterial occlusive disease

Shankar

Handa

Hands

2008

Journal of Vascular Surgery

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“…Main comparisons regarded ticlopidine, aspirin, clopidogrel (Table 2). Outcome results of the 13 included studies (23,32,56,(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) are shown in Table 3. Clopidogrel, a ticlopidine-derived drug, was compared to aspirin in a large level 1 study (63).…”

Section: Comparative Studiesmentioning

confidence: 99%

Antithrombotic Drugs in the Primary Medical Management of Intermittent Claudication: A Meta-analysis

Girolami¹,

Bernardi²,

Prins³

et al. 1999

Thromb Haemost

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Summary Background. There is no consensus on the efficacy of the antithrombotic drugs available for patients with intermittent claudication. Methods. A Medline and manual search was used to identify relevant publications. Uncontrolled or retrospective studies, double reports or trials without clinical outcomes were excluded. Included studies were graded as level 1 (randomised and double- or assessor-blind), level 2 (open randomised), or level 3 (non-randomised comparative). Mortality, cerebro- or cardiovascular events, amputations, arterial occlusions or number of revascularization procedures performed in the lower limbs, pain-free and total walking distance, ankle brachial index and calf blood flow, were the main outcomes considered. When feasible, end of treatment results, either continuous or binary, were combined with appropriate statistical methods. Results. Mortality was significantly decreased by ticlopidine compared to placebo (common odds ratio 0.68, 95% C.I., 0.49 - 0.95); clopidogrel decreased vascular events in comparison to aspirin (odds ratio 0.76, 95% C.I., 0.63 - 0.92) in level 1 studies. Arterial occlusions and the number of revascularization procedures performed were statistically significantly decreased by aspirin and ticlopidine, respectively. A small but statistically significant improvement in pain-free walking distance was determined by picotamide, indobufen, low molecular weight heparins, sulodexide and defibrotide, in small studies. Conclusions. Clopidogrel and ticlopidine do reduce clinically important events in patients with intermittent claudication and could be added to the primary medical treatment of these patients. The use of aspirin in these patients cannot be based on direct evidence, but only on analogy with coronary and cerebral atherosclerosis, where it has documented efficacy. Other antithrombotic drugs were not properly evaluated in patients with intermittent claudication.

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“…Regarding oral anticoagulants, in a study by Dettori et al a positive effect on claudi cation was outweighed by the incidence of haemorrhagic side effects, especially when acenocoumarol was combined with pentoxyfylline [22], Finally, in an Italian study Calcium heparin given subcutaneously was judged to be as effective as ticlopidine in improving the walking distance of claudicant patients over three months [23], B2. Effect of antithrom botic drugs on progression of athero-thrombosis In a prospective double blind angiographic study of 2 years duration in 240 patients with POAD, Hess et al [24] were able to show a significant inhibition of the progres sion of the atherosclerotic lesions and a lesser incidence of new occlusions in patients treated with the combination Aspirin (1 g) plus Dipy ridamole (225 mg), in comparison with a placebo group, and a group with Aspirin alone.…”

Section: B) Intermittent Claudicationmentioning

confidence: 99%

Antithrombotic Drugs in Peripheral Obliterative Arterial Diseases

Coccheri¹,

Palareti²,

Fortunato³

1994

Pathophysiol Haemos Thromb

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In the natural history of patients with peripheral obliterative arterial disease (POAD) the prognosis of the complaint “intermittent claudication” is relatively good and the amputation rate is presently only about 3%. However, POAD patients carry a high risk of cardiovascular events and their cumultative mortality rate within 10 years is as high as 40-50%. Atherothrombotic events in the coronary and, less frequently, cerebral arteries are by far the first cause of death and disability in these patients. The rationale for antithrombotic drugs in the treatment of POAD lies in the pivotal role of platelet activation and thrombin formation in the evolution of the atherothrombotic lesions, but also in the effect of some of these drugs on the regulation of microcirculatory responses. In acute thrombotic arterial occlusion, Heparin is the “first application” drug, especially in support of interventional revascularisation procedures. Regional thrombolysis often coupled with angioplasty (PTA), or systemic thrombolysis, are effective in revascularisation of especially infrainguinal-supra popliteal occlusions. However, controlled clinical trials are needed. In chronic POAD, intermittent claudication can be improved with a rational walking exercise programme, but, besides pentoxyphilline, especially ticlopidine significantly adds to the benefits of exercise. Regarding districtual progression of atherothrombosis and especially cardiovascular events, both aspirin and ticlopidine have been shown effective in single studies or meta-analyses. In a recent observational study of pooled data the cumulative endpoint including myocardial infarction, stroke and vascular death was reduced by 25 ± 10% in the generality of patients treated with anti-platelet drugs. Finally, in critical limbs ischemia (CLI), some prostanoid compounds as Iloprost and Prostaglandin El favourably influence rest pain and ulcer healing, but less evidence is available on their effects on hard events as amputation and death. In conclusion, following the general indication to “be conservative” in the treatment of these patients, it seems clear that antithrombotic drugs have become by far a key medication in all different phases of POAD.

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Three-Month Therapy with Calcium-Heparin in Comparison with Ticlopidine in Patients with Peripheral Arterial Occlusive Disease at Leriche-Fontaine IIb Class

Cited by 12 publications

References 8 publications

Endogenous heparin activity is decreased in peripheral arterial occlusive disease

Endogenous heparin activity is decreased in peripheral arterial occlusive disease

Antithrombotic Drugs in the Primary Medical Management of Intermittent Claudication: A Meta-analysis

Antithrombotic Drugs in Peripheral Obliterative Arterial Diseases

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