Combined fibrinolytic therapy for critical limb ischemia in patients with diabetic foot syndrome

Abstract

Purpose – to compare the efficacy of urokinase and urokinase combined with low molecular weight heparin (Cibor 2500 mg) for the treatment of critical limb ischemia in diabetic foot.Material and methods. The first group of studies (IG 1) – 39 patients, received 1,0–0,05 million I U/day f or 20–26 days urokinase along with treatment protocol. The second group (IG 2) – 19 patients received treatment similar to one IG but while taking Cibor. Control Group (CG, 11 patients) recruited retrospectively. It was compared the dynamics of level of fibrinogen, TcPO2 and dynamics of ulcer healing (assessed by the beginning of treatment, at 10 and 20 days). Results. In both experimental groups dynamic of fibrinogen was statistically better than in the CG (p < 0,01) – its level reduced in an IG 1 and 2 f rom (4.55 ± 1.64) g/l and (4.82 ± 1.10) g/l to (2.43 ± 1.03) g/l and (2.57 ± 0.82) g/l after 20 days respectively. In CG level of fibrinogen decreased from (4.70 ± 1.18) g/l to (3.93 ± 1.01) g/l. There was no significant difference in the dynamic of fibrinogen between 1 and 2 IG. Just significantly (p <0.01) improved level of TcPO2 1 and 2 IG (f rom (10.36 ± 3.02) and (9.21 ± 3.05) mm Hg on the beginning to (19.26 ± 6.54) and (23.65 ± 3.12) mm Hg . at the end of treatment ) compared with the dynamics in the CG ((13. 50 ± 2.66) mm Hg at beginning and (14.80 ± 2.71) mm Hg at the end of treatment) . But with the additional use Cibor TcPO2 was statistically better on 10th ((15.32 ± 3.41) mm Hg vs (13.38 ± 3.36) mm Hg . ). and on the twentieth day. In the hospital after stabilizing among patients of IG 1 13 (33.33%) amputations were performed, including 3 – at the level of the famur, 3 – at the level of the shin, 7 – at the level of the foot. In IG 2 6 (31.58%) patients were perf ormed amputations , including 1- at lev el of the lower third of the femur, 1 – at the level of the shin, 4 – foot amputation level. In CG conducted 7 (64%), including 2 – at hip level, 2 – at the level of shin and 3 foot amputation level. Conclusions. Thus demonstrated the efficacy of a combination of urokinase with LMWH on the healing of ulcers in patients with critical ischemia of diabetic foot syndrome by reducing fibrinogen levels and improve blood circulation in the lower limbs.