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Göteborgs universitets publikationer

Beneficial effects of dalteparin on haemostatic function and local tissue oxygenation in patients with diabetes, severe vascular disease and foot ulcers.

Författare och institution:
Majid Kalani (-); Angela Silveira (-); Margareta Blombäck (-); Jan Apelqvist (-); Björn Eliasson (Institutionen för medicin); Jan W Eriksson (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); Bengt Fagrell (-); Ole Torffvit (-); Anders Hamsten (-); Gun Jörneskog (-)
Publicerad i:
Thrombosis research, 120 ( 5 ) s. 653-61
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
INTRODUCTION: A state of hypercoagulation and fibrinolytic dysfunction is present in individuals with diabetes, which may contribute to disturbed skin microcirculation and impaired ulcer healing. We have previously reported an improved outcome of chronic diabetic foot ulcers during treatment with dalteparin. In the present study we investigated the effects of dalteparin on skin microcirculation and haemostatic function. MATERIALS AND METHODS: 87 patients with diabetes, peripheral arterial obliterative disease and chronic foot ulcers were investigated in a prospective, randomised, double-blind and placebo-controlled study. They were randomised to treatment with subcutaneous injections of 5000 U dalteparin (n=44) or placebo (n=43), once daily until ulcer healing or for a maximum of six months. Plasma fibrinogen, fibrin gel structure [permeability coefficient (Ks) and fiber mass/length ratio (mu)], prothrombin fragment 1+2 (F1+2) antigen, plasminogen activator inhibitor-1 (PAI-1) activity and tissue plasminogen activator (tPA) antigen were analysed before randomization (baseline value), and at the end of the treatment period. The skin microcirculation of the foot was investigated by transcutaneous oxygen tension (TcPO(2)) and laser Doppler fluxmetry (LDF). RESULTS: The changes (Delta-values) of Ks, mu, tPA and TcPO(2) were higher (p<0.05) during treatment with dalteparin, as compared to the changes during treatment with placebo. At baseline, plasma fibrinogen and Ks were significantly correlated to TcPO(2). CONCLUSIONS: Local skin oxygenation improved and a less thrombogenic fibrin gel structure was formed in patients treated with dalteparin. Beneficial effects on haemostatic function are likely to contribute to the improved skin oxygenation observed during treatment with dalteparin.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin ->
Endokrinologi och diabetes ->
Aged, Dalteparin, therapeutic use, Diabetes Mellitus, drug therapy, Double-Blind Method, Female, Fibrinolytic Agents, therapeutic use, Foot Ulcer, drug therapy, Hemostasis, Humans, Kinetics, Male, Microcirculation, Middle Aged, Oxygen, metabolism, Skin, blood supply, Treatment Outcome, Vascular Diseases, drug therapy
Postens nummer:
Posten skapad:
2010-04-05 16:31
Posten ändrad:
2011-01-20 09:59

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