Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Beneficial effects of dalteparin on haemostatic function and local tissue oxygenation in patients with diabetes, severe vascular disease and foot ulcers. Thromb Res. 2007 Feb 1;
Kalani M, Silveira A, Blombäck M, Apelqvist J, Eliasson B, Eriksson JW, Fagrell B, Torffvit O, Hamsten A, Jörneskog G
Quote:
INTRODUCTION: A state of hypercoagulation and fibrinolytic dysfunction is present in individuals with diabetes, which may contribute to disturbed skin microcirculation and impaired ulcer healing. 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 healing or for a maximum of six months. Plasma fibrinogen, fibrin gel 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 (TcPO(2)) and laser Doppler fluxmetry (LDF).
RESULTS: The changes (Delta-values) of Ks, mu, tPA and TcPO(2) 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 TcPO(2).
CONCLUSIONS: Local skin oxygenation improved and a less thrombogenic fibrin gel 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.
Re: Dalteparin to improve haemostatic function in the diabetic foot
I am going to sound really cynical, bitter and twisted here, but while it is really fantastic that all these studies are being done to accelerate the healing of wounds in people who have diabetes, why aren't there more studies that aim at increasing foot screening of people with diabetes? How about ensuring that all those people with diabetes have a risk for amputation allocated to them and appropriate management implemented to PREVENT formation of ulceration - well, at least reduce incidence. Am I being too idealistic? Is this going to put people out of jobs, or lose pharmaceutical companies money? I am just a bit tired of these fantastic ideas to accelerate healing when we know the majority of these ulcers are preventable and we are not doing enough to prevent. In addition, if these ulcers are identified early enough, appropriate pressure redistribution (if a significant arterial process is not present) is able to heal most cases quickly - but it means identifying the problem early - another area that needs work.
An added peeve is that we, in our clinic, never get our hands on these fantastic super new products - they cost too much!
Dalteparin to improve haemostatic function in the diabetic foot
Linear Mode
