title: Impact of optimal anticoagulation therapy on chronic venous ulcer healing in thrombophilic patients with post-thrombotic syndrome.
abstract: OBJECTIVE
  Post-thrombotic syndrome (PTS) is the long-term sequelae of deep venous thrombosis (DVT). PTS clinical manifestations include chronic leg pain, oedema, lipodermatosclerosis and ulcers. The objective of this study is to determine in patients with documented history of thrombophilias and DVT whether the number of previous thrombotic events and optimal anticoagulation therapy are associated with the time to venous ulcer healing following the start of compression therapy.
  
  
  METHODS
  Retrospective analysis performed in thrombophilic patients under the age of 50 years old with chronic venous ulcers secondary to DVT at the wound clinic in the National Institute of Medical Sciences and Nutrition 'Salvador Zubirán ' in Mexico City. Variables such as the number or episodes of thrombotic events, type of hypercoagulable disorder, optimal anticoagulation therapy with Warfarin monitored by therapeutic International Normalised Ratio (INR) (2-3) and compliance to compression therapy were examined. Patients that underwent superficial or perforator vein interruption or endovascular recanalisation of deep veins were excluded from the study.
  
  
  RESULTS
  From a database of 29 patients with chronic venous ulcers followed in our clinic from January 1992 to September 2012, only 13 patients (61% female) met the inclusion criteria. Mean age±standard deviation (SD) was 32±12 years old. Of these, seven (54%) patients with suboptimal INR presented with an average of two previous thrombotic events and the remaining six (46%) patients with optimal INR only one event (p=0.28), the mean time to the clinical manifestation of a venous ulcer after the first episode of DVT was 39 months (range: 12-72) for patients with suboptimal INR and 82 months (range: 12-216) for those with optimal anticoagulation therapy (p=0.11). During the mean follow-up period of 52 months, all patients in optimal anticoagulation healed their ulcer; their mean time for wound healing was 44 months (range: 4-102). In the suboptimal INR group, only four healed the ulcers with an mean of 72 months (range: 2-204) (p=0.94).
  
  
  CONCLUSIONS
  There seems to be an association between an optimal anticoagulation therapy with Warfarin monitored by INR and wound healing rates in thrombophilic patients with chronic venous ulcers. Further research is warranted.
  
  
  BACKGROUND
  The authors have no conflict of interest.
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran'. Wound Clinic Department of Surgery, Section of Vascular Surgery and Endovascular Therapy Mexico City, Mexico.
authors.forename: C A
authors.initials: CA
authors.lastname: Hinojosa
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran'. Wound Clinic Department of Surgery, Section of Vascular Surgery and Endovascular Therapy Mexico City, Mexico.
authors.forename: S
authors.initials: S
authors.lastname: Olivares-Cruz
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran'. Wound Clinic Department of Surgery, Section of Vascular Surgery and Endovascular Therapy Mexico City, Mexico.
authors.forename: H
authors.initials: H
authors.lastname: Laparra-Escareno
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran'. Wound Clinic Department of Surgery, Section of Vascular Surgery and Endovascular Therapy Mexico City, Mexico.
authors.forename: S
authors.initials: S
authors.lastname: Sanchez-Castro
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran'. Wound Clinic Department of Surgery, Section of Vascular Surgery and Endovascular Therapy Mexico City, Mexico.
authors.forename: B
authors.initials: B
authors.lastname: Tamayo-Garcia
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran'. Wound Clinic Department of Surgery, Section of Vascular Surgery and Endovascular Therapy Mexico City, Mexico.
authors.forename: J E
authors.initials: JE
authors.lastname: Anaya-Ayala
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D002908:Chronic Disease; D058128:Compression Bandages; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D054070:Postthrombotic Syndrome / Q000150:complications*; D012189:Retrospective Studies; D014647:Varicose Ulcer / Q000628:therapy*; D014859:Warfarin / Q000008:administration & dosage*; D014945:Wound Healing
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulation therapy; chronic venous ulcers; deep venous thrombosis; post-thrombotic syndrome; thrombophilias; wound healing