Stasis ulcers refractory to therapy--accelerated healing by treatment with clopidogrel +/- dalteparin: a preliminary report.
Stasis ulcers are commonly the result of chronic venous insufficiency. We have recently assessed 15 patients with stasis ulcers that failed to heal after one year of routine wound care. All patients demonstrated a defect in hemostasis, and a biopsy revealed livido vasculitis. Eleven of fifteen patients were treated with clopidogrel and dalteparin, and 4 of 15 patients were treated with clopidogrel alone. Thirteen of fifteen patients (86.6%) completely healed within three months of starting antithrombotic therapy. Patients with stasis ulcers and chronic venous insufficiency who fail to heal with routine wound care should be subjected to biopsy, a procoagulant defect evaluation, and initiation of clopidogrel and dalteparin therapy if a defect is found.
Bick
R L
RL
University of Texas Southwestern Medical Center, Dallas Thrombosis Hemostasis & Vascular Medicine Clinical Center, 75231, USA. rbick@onramp.net
Scott
R G
RG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000592:standards; D016736:Antiphospholipid Syndrome / Q000150:complications; D000077144:Clopidogrel; D017985:Dalteparin / Q000008:administration & dosage* / Q000592:standards; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000592:standards; D019851:Thrombophilia / Q000097:blood / Q000150:complications; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000592:standards; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D020246:Venous Thrombosis / Q000150:complications
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D017985:Dalteparin