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[Activated protein C resistance and cardiolipin antibodies in leg ulcers]
V Maréchal1, E De Maistre, A Barbaud
1Service de Dermatologie, Hôpital Fournier, 36, quai de la Bataille, 54035 Nancy.
Insights
Activated protein C resistance and anticardiolipin antibodies were investigated in 115 leg ulcer patients. While these clotting abnormalities were common, their prevalence did not differ significantly across venous, arterial, or arteriovenous ulcers.
Area of Science:
- Vascular Medicine
- Hematology
- Clinical Pathology
Background:
- Leg ulcers represent a significant clinical challenge with complex etiologies.
- Understanding the role of coagulation disorders in leg ulcer pathophysiology is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of activated protein C resistance (APC-R) and anticardiolipin antibodies (aCL) in patients with venous, arterial, and arteriovenous leg ulcers.
- To investigate potential differences in the prevalence of these thrombophilic factors among different types of leg ulcers.
Main Methods:
- Prospective study of 115 hospitalized leg ulcer patients without antiphospholipid syndrome.
- Vascular assessment using clinical examination, Doppler, duplex Doppler, and arteriography.
- APC-R assessed via classic and second-generation tests, with Factor V Leiden screening.
- Anticardiolipin antibodies measured using ELISA with Harris standards.
Main Results:
- Prevalence of APC-R (Factor V Leiden) was 10.4% (12/115) and significant anticardiolipin antibodies were found in 42.6% (49/115) of patients.
- APC-R was identified in 7 venous, 3 arteriovenous, and 2 arterial ulcers.
- Anticardiolipin antibodies were detected in 21 venous, 18 arteriovenous, and 10 arterial ulcers.
- No statistical difference in APC-R or aCL prevalence was observed between the three types of leg ulcers.
Conclusions:
- The prevalence of APC-R in leg ulcers was comparable to the general population.
- Factor V Leiden or anticardiolipin antibody abnormalities were found in 48.7% of patients, with no significant difference across ulcer types.
- The complex pathophysiology of leg ulcers suggests multiple contributing coagulation perturbations.
Background:
We conducted a prospective study to determine the prevalence of activated protein C resistance and anticardiolipin antibodies in leg ulcers, whatever venous, arterial or arteriovenous.
Patients And Methods:
One hundred fifteen patients hospitalized for leg ulcers, without antiphospholipid syndrome were included. The vascular abnormalities were studied by clinical examination, Doppler, duplex Doppler and, when required, arteriography. Activated protein C resistance was isolated by a "classic" test (normalized APTT ratio in PCa presence or absence) and by a "second generation test" (by preliminary dilution with deficient factor V plasma). All patients with abnormal results on the second test were screened for the factor V Leiden (by PCR amplication with use of restriction enzymes). Anticardiolipin antibodies were investigated with an ELISA method with Harris standards as reference, in which the positive threshold was established at 20 units.
Results:
Among these 115 patients, 50 venous (43.5 p. 100), 23 arterial (20 p. 100), 42 arteriovenous (36.5 p. 100) leg ulcers were identified. Activated protein C resistance was isolated in 12 cases (10.4 p. 100) (heterozygous carriers): 7 venous ulcers, 3 arteriovenous, 2 arterial. Anticardiolipin antibodies were measured at significant level in 49 cases (42.6 p. 100): 21 venous ulcers, 18 arteriovenous, 10 arterial.
Discussion:
In this study, there was no statistical difference between the activated protein C resistance prevalence in leg ulcers when compared with Lorraine population (p=0.27). Factor V Leiden or anticardiolipin antibodies abnormalities were isolated in 56 cases (48.7 p. 100) without statistical difference between the 3 types of ulcers. Finally, the pathophysiology of venous, arterial and arteriovenous leg ulcers remains complex, suggesting several coagulation perturbations.