scholarly journals Effect of Direct Oral Anticoagulants for Ulcer Epithelization and Laser Doppler Flowmetry Parameters In Patients with Diabetic Foot Syndrome and Atrial Fibrillation

2021 ◽  
Vol 17 (4) ◽  
pp. 552-556
Author(s):  
V. I. Petrov ◽  
N. V. Rogova ◽  
T. N. Кuzmina ◽  
A. S. Lishuta
Keyword(s):  
Diabetic Foot ◽  
Pulse Wave ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Doppler Flowmetry ◽  
Group 2 ◽  
Respiratory Wave ◽  
Group 1

Aim. To study changes in epithelialization of diabetic foot ulcers and parameters of laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) and atrial fibrillation (AF) during complex therapy with the addition of direct oral anticoagulants (DOAC).Material and methods. An open-label comparative randomized study in parallel groups was performed. Patients with neuroischemic DFS and persistent FA without previous anticoagulant therapy were randomized into two groups: combination therapy for DFS and rivaroxaban (group 1; n=24) or combination therapy for DFS and dabigatran (group 2; n=22). Changes in local status in diabetic foot ulcers, coagulogram parameters and LDF were studied at 4 and 12 weeks.Results. Complete epithelialization of diabetic foot ulcers after 12 weeks was found in 14 (58.3%) patients in group 1, and in 10 (45.4%) patients in group 2. Statistically significant improvements in LDF parameters were found in both groups in both groups: an increase in the microcirculation index by 53.5% (p=0.02), pulse wave by 124.0% (p=0.003), respiratory wave by 59.4% (p=0.007) was found in group 1. An increase in the microcirculation index by 48.5% (p=0.02), pulse wave by 73.1% (p=0.003), respiratory wave by 47.1% (p=0.03) were found in group 2.Conclusion. Positive statistically significant changes in epithelialization of diabetic foot ulcers and LDF parameters were found in patients with DFS and AF during 12 weeks of complex therapy with the addition of DOACs (rivaroxaban and dabigatran). Further research for DOACs in DFS patients is needed.

Benefits of Acidifying Agents in Local Therapy of Diabetic Foot Ulcers Infected by Pseudomonas sp: A Pilot Study

2019 ◽  
Vol 18 (3) ◽  
pp. 262-268 ◽  
Author(s):  
Vladimíra Fejfarová ◽  
Hana Tibenská ◽  
Jitka Niklová ◽  
Robert Bém ◽  
Michal Dubský ◽  
...  
Keyword(s):  
Pilot Study ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Local Therapy ◽  
Study Groups ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Pseudomonas Sp ◽  
Group 2 ◽  
Group 1

Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents—particularly acidifying solutions—on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by Pseudomonas species. Patients were divided into 2 groups according to the local therapy provided: group 1 (n = 15)—modern local treatment; group 2 (n = 17)—acidifying antiseptic solutions. The study groups differed only with regard to ATB usage prior to enrolment in the study ( P = .004), but did not differ with regard to age, diabetes control, peripheral arterial disease, or microcirculation status. During the follow-up period, DFUs healed in 20% of cases in group 1, but there were no cases of healing in group 2 (NS). The length of ATB therapy, the number of new osteomyelitis, lower limb amputations, and the changes of DFUs status/proportions did not differ significantly between study groups. Pseudomonas was eradicated in 67% of cases in group 1 and in 65% of cases in group 2. The local treatment given to group 2 patients was associated with lower costs ( P < .0001). Conclusion. Acidifying agents had the same effect as modern healing agents on wound healing, the number of amputations, and the eradication of Pseudomonas. Moreover, therapy performed using acidifying solutions proved in our pilot study markedly cheaper.

scholarly journals Topical Administration of Pirfenidone Increases Healing of Chronic Diabetic Foot Ulcers: A Randomized Crossover Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Marcela Janka-Zires ◽  
Paloma Almeda-Valdes ◽  
Ana Cecilia Uribe-Wiechers ◽  
Sonia Citlali Juárez-Comboni ◽  
Joel López-Gutiérrez ◽  
...  
Keyword(s):  
Crossover Study ◽  
Diabetic Foot ◽  
Conventional Treatment ◽  
Topical Administration ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Group 2 ◽  
To Receive ◽  
Randomized Crossover Study ◽  
Group 1

Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P=0.025). Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P=0.081). By week 8, the reduction in ulcer size was 100% [73–100] with pirfenidone versus 57.5% with conventional treatment [28.9–74] (P=0.011). By week 16, the reduction was 93% [42.7–100] with pirfenidone and 21.8% [8–77.5] with conventional treatment (P=0.050). The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers.

Efficacy of Recombinant Human Epidermal Growth Factor (Regen-D 150) in Healing Diabetic Foot Ulcers: A Hospital-Based Randomized Controlled Trial

2019 ◽  
Vol 19 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Vijay Viswanathan ◽  
Udyama Juttada ◽  
Mary Babu
Keyword(s):  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Diabetic Foot ◽  
Complete Healing ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Human Epidermal Growth Factor ◽  
Epidermal Growth ◽  
Group 2 ◽  
Group 1

To validate the efficacy of recombinant human epidermal growth factor (hEGH) in healing diabetic foot ulcers (DFUs) at biochemical and molecular levels. A total of 50 noninfected DFU subjects were recruited for the study and divided into 2 groups based on the treatment application on the subjects. Group 1: DFU subjects treated with hEGH gel-based product called Regen-D 150 (n = 27) and group 2: DFU subjects treated with alternative placebo as the control group (n = 23). Patients were observed for 30 days and punch biopsy was taken at days 0 and 14. Histologic analysis was done to study the matrix alignment, cellular infiltration, and differentiation of epithelial layers. Biochemical analysis was done to quantitatively estimate the amount of collagen and proteoglycans regenerated in the wound area. Complete healing of ulcers was observed in 21 (78%) subjects in group 1, whereas only 12 (52%) subjects among group 2 reported of complete healing of ulcer after completion of the study period of 30 days. Collagen and fibroblasts were significantly developed in group 1 when observed in the follow-up samples. Healing time of the wound among the group 1 subjects was significantly less than the group 2 subjects (45 ± 12 vs 72 ± 18 days, P < .0001) and even showed a better blood glucose level. Early and regular application of the hEGH on DFUs will lead to prevention of leg amputations and would serve to act as a major treatment therapy for healing of chronic wounds.

scholarly journals A mixed methodology, non-interventional study to evaluate the use of direct oral anticoagulants in UK clinical practice for patients with a first stroke associated with non-valvular atrial fibrillation: study protocol

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yaqoob Bhat ◽  
Anand Dixit ◽  
Amit Mistri ◽  
Bhavini Patel ◽  
Sadat Haider Quoraishi ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Mixed Methodology ◽  
Interventional Study ◽  
Patient Reported ◽  
Secondary Endpoints ◽  
Group 2 ◽  
Group 1

Abstract Background Treatment with anticoagulants, including direct oral anticoagulants (DOACs), should be considered for patients diagnosed with atrial fibrillation (AF) deemed at risk of ischaemic stroke. There are limited real world data related to the characteristics of patients with non-valvular AF who were not taking anticoagulants at the time of first ischaemic stroke and their subsequent DOAC treatment for the secondary prevention of stroke. Furthermore, little is known about patient adherence and experiences of DOAC treatment, especially for patients with non-valvular AF receiving DOAC therapy for the secondary prevention of stroke. Methods This is a UK mixed methodology, non-interventional study, involving retrospective and prospective medical record reviews and a prospective patient survey, in progress in six UK National Health Service secondary/tertiary care centres. The study comprises two groups of patients. Group 1 will include 300 eligible consenting patients with a first ischaemic stroke associated with non-valvular AF untreated with anticoagulants in the 12 months prior to stroke. Group 2 will include a subgroup of 150 patients from Group 1 initiated on one of the DOACs targeting activated Factor X (n = 50 on apixaban, n = 50 on edoxaban and n = 50 on rivaroxaban). The primary endpoint of the study is the CHA2DS2-VASc Risk Score prior to initiation of anticoagulation for patients included in Group 1. Secondary endpoints to be evaluated in Group 1 include patient demographics, clinical characteristics, relevant medical history, anticoagulant therapy initiated for secondary prevention of stroke, and relevant concomitant medication. Secondary endpoints to be evaluated in Group 2 include the time between stroke and DOAC initiation; prescribing of DOACs, other anticoagulants and concomitant medication; clinical assessments and hospital resource use; patient reported outcome measures, including the Morisky Medication Adherence Scale questionnaire and the Treatment Satisfaction Questionnaire for Medication. Discussion This mixed methodology study will provide new real world insights into the characteristics and management pathways and patient-reported experiences of this important group of patients. It is anticipated that the results of this study will provide the medical community and patients with important information to inform clinical decision-making and help facilitate meaningful improvements in the care of patients with non-valvular AF.

Compliance to antithrombotic therapy in elderly and senile patients with atrial fibrillation.

2019 ◽  
Author(s):  
М.В. Хруслов ◽  
М.А. Карпенко ◽  
Т.В. Вавилова ◽  
И.В. Пономарева
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Laboratory Model ◽  
Nonvalvular Atrial Fibrillation ◽  
Effective Prevention ◽  
Group 2 ◽  
Group 1

Введение. Приверженность к приему антикоагулянтов является одним из ключевых компонентов эффективной профилактики тромбоэмболических осложнений. Цель исследования: оценка комплаентности пациентов пенсионного возраста, которым назначали прямые оральные антикоагулянты (ПОАК) по поводу неклапанной фибрилляции предсердий (ФП), и выяснение причин ее снижения. Материалы и методы. В ходе исследования осуществляли наблюдение за 244 пациентами с неклапанной ФП. В зависимости от вида принимаемых оральных антикоагулянтов все пациенты были разделены на 2 группы: 1я группа 124 человека, которые принимали ПОАК 2я группа 120 человек, которые принимали варфарин и наблюдались в системе централизованного мониторинга международного нормализованного отношения (МНО). Срок наблюдения составил 1 год. Результаты. Через 1 год от момента назначения препаратов назначения врача соблюдали только 22,6 пациентов 1й группы во 2й группе пациентов никто не прекратил прием варфарина, что указывало на более высокую приверженность к терапии. Заключение. Одним из способов повышения качества и безопасности антитромботической терапии у пациентов, принимающих антагонисты витамина К, является внедрение в клиническую практику системы централизованного мониторинга МНО, которая представляет собой новую клиниколабораторную Introduction. Adherence to anticoagulants is one of the key components of effective prevention of thromboembolic complications. Aim: to assess the compliance of patients of retirement age who were prescribed direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF), and to determine the reasons for its reduction. Materials and methods. We monitored 244 patients with nonvalvular AF that were divided into 2 groups: Group 1 124 patients who took DOACs Group 2 120 patients who took warfarin and were observed in the system of centralized monitoring of international normalized ratio (INR). The observation period was 1 year. Results. After 1 year from the moment of drugs prescribing only 22.6 of patients from Group 1 followed the prescription no one patient from Group 2 stopped taking warfarin that indicated a higher adherence to therapy. Conclusion. One of the ways to improve the quality and safety of antithrombotic therapy in patients taking vitamin K antagonists is to introduce into the clinical practice a system of centralized monitoring of INR that is a new clinical and laboratory model of remote interaction between patient and medical specialist.

Patterns of anticoagulation for atrial fibrillation in cancer patients referred for cardio-oncological evaluation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Toma ◽  
E Rrapaj ◽  
S Giovinazzo ◽  
M Sarocchi ◽  
G Stronati ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Creatinine Concentration ◽  
Pharmacological Interactions ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Direct oral anticoagulants (DOAC) are the standard of care for the prophylaxis of non-valvular atrial fibrillation (NVAF)-cardioembolism, but their use in oncological patients has been limited so far. Methods We retrospectively reviewed the records of the patients referred to two cardio-oncology outpatient units between January 2017 and July 2019, and selected those presenting with NVAF, CHA2DS2-VASc ≥1 for men and ≥2 for women, and cancer on active treatment. The following were considered as contraindications to DOAC: severe chronic kidney disease; anti-neoplastic therapy unknown or with potential moderate-to-severe adverse interactions; cirrhosis or liver metastases. Clinical characteristics of patients on DOAC (group 1), on VKA or LMWH with at least 1 contraindication to DOAC (group 2), and on VKA or LMWH despite not having contraindications to DOAC (group 3) were compared by chi-square or ANOVA. Results Of a total of 3,831 patients, 264 (6.9%) met the inclusion criteria (Figure 1). One-hundred fourteen (43.2%) were in group 1, 61 (23.1%) in group 2 (18 on VKA, 43 on LMWH), and 65 (24.6%) in group 3 (27 on VKA, 38 on LMWH). Anticoagulation was omitted in 24 (9.1%) cases for various reasons: spontaneous bleeding (5), anaemia and/or thrombocytopenia (5), frailty (4), CHA2DS2-VASc 1 (3), pharmacological interactions (1), single episode of NVAF (1); and not clearly motivated in 5 subjects. The only significant difference between the 3 groups was serum creatinine concentration (Table 1). Of note, only 10% of subjects in group 1 received an inappropriate DOAC dose, while LMWH was under-dosed for 18% of patients in group 2 and 31% of patients in group 3 (P=0.002). Conclusions In the setting of a dedicated cardio-oncology consultation, DOAC and VKA are most often appropriately prescribed to cancer patients with NVAF. However, there is residual use of LMWH, not infrequently at non-anticoagulant dosage. This is a non-evidence based common practice in clinical oncology that clearly must be abandoned Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Clinical and morphological characteristics with markers of reparation in neuropathic diabetic foot ulcers.

2015 ◽  
Vol 18 (3) ◽  
pp. 70-76 ◽  
Author(s):  
Elena Yurievna Komelyagina ◽  
Evgenia Aleksandrovna Kogan ◽  
Mikhail Borisovich Antsiferov
Keyword(s):  
Smooth Muscle ◽  
Diabetic Foot ◽  
Smooth Muscle Actin ◽  
Morphological Characteristics ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Muscle Actin ◽  
Ki 67 ◽  
Group 3 ◽  
Group 1

Aim. To compare the clinical and morphological characteristics of chronic diabetic foot ulcers and the markers of repair.Materials and Methods.We included 26 patients with neuropathic diabetic foot syndrome who had signs of severe peripheral neuropathy. Biopsies were performed from the margin and central part of the lesion and were fixed in a 10% formalin solution before being placed on paraffin slides and stained with hematoxylin and eosin. We assessed the percentages of necrotic, granulation and fibrotic tissues and the severity of vascular hyalinosis. Immunohistochemistry was performed with initial antibodies to Ki-67 (a marker of proliferation), smooth muscle actin (a marker of myofibroblast synthesis) and cytokeratin (a marker of epithelisation). For analysis, the samples were divided into three groups by the length of time the ulcer had been present: group 1 (≤90 days; 9 samples), group 2 (91–365 days; 10 samples) and group 3 (365 days; 9 samples).Results. The patients of group 3 were older than those of groups 1 and 2 (53.7±2.7 vs 51.7±5.9 vs 59.9±5.6 years; p=0.04). There were no differences in the duration of diabetes, glycated haemoglobin or severity of neuropathy. The percentage of necrotic tissue was higher in group 1 (33.7%±21.7% vs 11.0%±3.9% vs 12.8%±6.1%; p=0.02) and the percentage of fibrotic tissue was highest in group 3 (21.1%±21.0% vs 35.5%±19.8% vs 54.4%±23.9%; p=0.001). However, the amount of granulation tissue was not different between the groups (45.2%±21.1% vs 53.5%±21.1% vs 32.8%±26.3%; p=0.4). There was also no difference in the severity of vascular hyalinosis between the groups (p=0.9). Expression of Ki-67 was higher in groups 1 and 2, implying a greater capacity to regenerate. The expression of smooth muscle actin and cytokeratin was higher in groups 1 and 2 but without statistical significance.Conclusion. The morphological characteristics and regenerative capacities of neuropathic diabetic foot ulcers differ with the duration the ulcer has been present. Patients with ulcers for less than 1 year were characterised by higher cell proliferation but lower fibrosis. Neuropathic diabetic foot ulcers that are unable to heal over a year are characterised by incomplete regeneration and higher levels of fibrosis. Thus, different treatment approaches are needed depending on how long an ulcer has been present.

scholarly journals Hyperglycemia Increases Susceptibility to Ischemic Necrosis

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
D. Lévigne ◽  
M. Tobalem ◽  
A. Modarressi ◽  
B. Pittet-Cuénod
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Limb Ischemia ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Tissue Necrosis ◽  
Doppler Flowmetry ◽  
Per Se ◽  
Underlying Mechanisms

Diabetic patients are at risk for spontaneous foot ulcers, chronic wounds, infections, and tissue necrosis. Current theories suggest that the development and progression of diabetic foot ulcers are mainly caused by arteriosclerosis and peripheral neuropathy. Tissue necrosis plays a primordial role in the progression of diabetic foot ulcers but the underlying mechanisms are poorly understood. The aim of the present study was to investigate the effects of hyperglycemiaper seon the susceptibility of ischemic tissue to necrosis, using a critical ischemic hind limb animal model. We inflicted the same degree of ischemia in both euglycemic and streptozotocin-induced hyperglycemic rats by resecting the external iliac, the femoral, and the saphenous arteries. Postoperative laser Doppler flowmetry of the ischemic feet showed the same degree of reduction in skin perfusion in both hyperglycemic and euglycemic animals. Nevertheless, we found a significantly higher rate of limb necrosis in hyperglycemic rats compared to euglycemic rats (71% versus 29%, resp.). In this study, we revealed that hyperglycemiaper seincreases the susceptibility to limb necrosis in ischemic conditions. Our results may help to better understand the physiopathology of progressive diabetic wounds and underline the importance of strict glycemic control in patients with critical limb ischemia.

Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity

2021 ◽  
pp. 153473462098223
Author(s):  
Jialu Wu ◽  
Min Liu ◽  
Hui Huang
Keyword(s):  
Risk Factors ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Diabetic Foot ◽  
Pulse Wave ◽  
Ankle Brachial Index ◽  
Foot Ulcers ◽  
Binary Logistic Regression Analysis ◽  
Diabetic Foot Ulcers ◽  
Factors Associated

To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.

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