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Intravenous hydroxyethylrutosides combined with long-term oral anticoagulation in atherosclerotic nonreconstructable
1Department of Clinical Physiology of Karolinska Hospital and Södersjukhuset, Stockholm, Sweden.
Insights
Patients with severe chronic critical leg ischemia (CLI) receiving hydroxyethylrutosides (HR) infusions and warfarin anticoagulation (AC) showed improved survival and limb salvage. This combined therapy offers a promising treatment option for CLI, comparable to other advanced treatments.
Area of Science:
- Vascular Medicine
- Pharmacology
- Clinical Physiology
Background:
- Chronic critical leg ischemia (CLI) presents a significant challenge, often leading to amputation or death.
- Nonreconstructable CLI necessitates innovative therapeutic strategies to improve patient outcomes.
Purpose of the Study:
- To assess the short-term effects of hydroxyethylrutosides (HR) combined with warfarin anticoagulation (AC) on lower limb microcirculation.
- To evaluate the long-term clinical outcomes, specifically amputation rates and mortality, in CLI patients treated with HR + AC.
Main Methods:
- A retrospective comparative study involving seventy patients diagnosed with CLI.
- Two groups were compared: one receiving standard therapy plus HR infusions and oral AC, and a control group receiving only standard therapy.
- Patients were monitored for 24 months, with assessments including clinical data, skin temperature, and fluorescein imaging.
Main Results:
- The combination of HR infusions and long-term oral AC demonstrated beneficial short-term effects on cutaneous microvascular blood perfusion.
- Patients treated with HR + AC experienced improved limb salvage and survival rates compared to the reference group.
- The efficacy of this combined therapy was found to be comparable to intravenous prostacyclin analogs.
Conclusions:
- Combined therapy with hydroxyethylrutosides and oral anticoagulation is effective in improving outcomes for patients with severe, nonreconstructable CLI.
- This treatment approach offers a viable option for limb salvage and enhanced survival in high-risk CLI patients.
Objective:
To evaluate in a group of seriously diseased patients with nonreconstructable chronic critical leg ischemia (CLI), treated by a combination of i.v. hydroxyethylrutosides (HR)* and oral anticoagulation (AC) by warfarin, the short-term effects on the cutaneous microvascular blood perfusion of the soles of feet and especially the long-term clinical outcome in terms of amputation and death.
Design:
A retrospective comparison between two groups of patients, HR + AC and a comparable reference group, fulfilling the same inclusion and exclusion criteria corresponding to the definition of CLI according to the Second European Consensus Document (1991). Clinical follow-up in both groups was made after 1, 3, 6, 12, and 24 months.
Setting:
Patients were examined at university departments of clinical physiology with special interest in peripheral vascular disease, in cooperation with colleagues at university departments of surgery, internal medicine and dermatology of Karolinska Hospital, Södersjukhuset and Huddinge Hospital.
Patients:
A total of seventy patients with CLI according to the definition of the Second European Consensus Document, 1991, ie, besides severe rest pain or ischemic lesions also a toe blood pressure < 30 mg Hg. Group with HR + anticoagulation (AC): 42 patients (19 diabetics, 23 nondiabetics). Reference group: 28 patients (18 diabetics, 10 nondiabetics). For distribution of age and toe blood pressure at baseline, see Table I.
Interventions:
Therapy group: besides ordinary standard therapy, daily HR infusions for a mean period of 3.6 weeks + oral anticoagulation continued to the end of the study at 24 months. A comparable reference group on the same basic therapy but without the combination HR + AC. PARAMETERS IN EVALUATION: Short-term parameters: clinical data, skin temperature, and fluorescein imaging. Long-term outcome: amputation or death.
Results:
Short-term and long-term results with HR + AC indicated that patients with severe CLI and very poor prognosis benefited in terms of survival and limb salvage from initial therapy with HR infusion combined with long-term oral anticoagulation. Results of this combined treatment seem at least comparable with those with i.v. prostacyclin analogies.
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