Low molecular weight heparin seems to improve local capillary circulation and healing of chronic foot ulcers in diabetic patients.
Ten diabetic patients with peripheral arterial occlusive disease, peripheral polyneuropathy and chronic foot ulcers were given 2500 U low molecular weight heparin (Fragmin, Kabi-Pharmacia AB, Sweden) subcutaneously once a day during 8 weeks. The mean age was 63 (47-80) years and the mean duration of foot ulcers 8 (4-12) months. All patients had previously received conventional treatment during 12 weeks, without any noticeable improvement on ulcer healing. The ulcer area was measured, and the skin microcirculation of the forefoot and around the ulcers was investigated before, during and after treatment with Fragmin. The total skin microcirculation was measured by laser Doppler fluxmetry, the nutritional skin microcirculation by vital capillaroscopy and the macrocirculation by determination of the ankle/arm pressure ratio. The ulcer area decreased significantly in eight patients of which four healed the ulcers completely. Of the remaining two patients one deteriorated, whereas one showed a decrease of the ulcer area during treatment, but an increase when treatment was stopped. The macro- and total microcirculation were unchanged in all patients, whereas the nutritional capillary circulation improved in seven out of nine patients, concomitantly with clinical improvement. The biological zero value (a flow-independent part of the LD signal) was high in 4 patients before treatment, but decreased during treatment and remained low even after treatment with Fragmin.-The results indicate that Fragmin positively influences the healing process of chronic foot ulcers in diabetic patients, possibly by improving the capillary circulation in the ulcer margin, in spite of an unchanged arterial and total skin microcirculation of the region.
Karolinska Institute, Department of Medicine, Karolinska Hospital, Stockholm.
G
G
Jörneskog
K
K
Brismar
B
B
Fagrell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000188:drug therapy*; D005260:Female; D005528:Foot / Q000098:blood supply; D016523:Foot Ulcer / Q000188:drug therapy*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D012867:Skin / Q000098:blood supply; D014945:Wound Healing / Q000187:drug effects*
D006495:Heparin, Low-Molecular-Weight