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

Kalani, Majid; Silveira, Angela; Blomback, Margareta; Apelqvist, Jan LU ; Eliasson, Bjorn; Eriksson, Jan W.; Fagrell, Bengt; Torffvit, Ole LU ; Hamsten, Anders and Jorneskog, Gun (2007) In Thrombosis Research 120(5). p.653-661
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 heating. 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... (More)
Introduction: A state of hypercoagulation and fibrinolytic dysfunction is present in individuals with diabetes, which may contribute to disturbed skin microcirculation and impaired ulcer heating. 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 heating or for a maximum of six months. Plasma fibrinogen, fibrin get 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 (TcPO2) and laser Doppler ftuxmetry (LDF). Results: The changes (A-values) of Ks, mu, tPA and TcPO2 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 TcPO2. Conclusions: Local skin oxygenation improved and a less thrombogenic fibrin get 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. (C) 2007 Elsevier Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
heparin, molecular weight, low, fibrin get, fibrinotysis, blood coagulation, diabetes mellitus, microcirculation
in
Thrombosis Research
volume
120
issue
5
pages
653 - 661
external identifiers
  • wos:000249543100003
  • scopus:34547954352
ISSN
1879-2472
DOI
10.1016/j.thromres.2006.12.006
language
English
LU publication?
yes
id
9fc0497d-21ba-4d28-a970-4324191c0f61 (old id 656339)
date added to LUP
2007-12-12 11:14:00
date last changed
2017-07-30 03:53:56
@article{9fc0497d-21ba-4d28-a970-4324191c0f61,
  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 heating. 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 heating or for a maximum of six months. Plasma fibrinogen, fibrin get 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 (TcPO2) and laser Doppler ftuxmetry (LDF). Results: The changes (A-values) of Ks, mu, tPA and TcPO2 were higher (p&lt;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 TcPO2. Conclusions: Local skin oxygenation improved and a less thrombogenic fibrin get 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. (C) 2007 Elsevier Ltd. All rights reserved.},
  author       = {Kalani, Majid and Silveira, Angela and Blomback, Margareta and Apelqvist, Jan and Eliasson, Bjorn and Eriksson, Jan W. and Fagrell, Bengt and Torffvit, Ole and Hamsten, Anders and Jorneskog, Gun},
  issn         = {1879-2472},
  keyword      = {heparin,molecular weight,low,fibrin get,fibrinotysis,blood coagulation,diabetes mellitus,microcirculation},
  language     = {eng},
  number       = {5},
  pages        = {653--661},
  series       = {Thrombosis Research},
  title        = {Beneficial effects of dalteparin on haemostatic function and local tissue oxygenation in patients with diabetes, severe vascular disease and foot ulcers},
  url          = {http://dx.doi.org/10.1016/j.thromres.2006.12.006},
  volume       = {120},
  year         = {2007},
}