Anticoagulation Therapy with Bemiparin in Combination Treatment of Patients with Diabetic Peripheral Neuropathy and Latent Ischemia of Lower Limb Tissues

Authors

  • M.B. Gorobeiko Ukrainian Scientific and Practical Centre for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of Ministry of Healthcare of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0721.5.61.2014.76845

Abstract

It is known that diabetic peripheral neuropathy as well as microangiopathy increases risk of diabetic foot syndrome development even with preserved patency of main arteries of the lower limbs. In this paper we examined the efficacy of anticoagulation therapy using low molecular weight heparin of second generation — bemiparin in combination treatment of patients with diabetic peripheral neuropathy with latent feet ischemia. The study included 48 patients with diabetes mellitus type 2 and instrumentally confirmed diabetic peripheral neuropathy without occlusion of main arteries of the lower limbs. Of these, 34 were main group, 14 — control one. Patients of the study group were hospitalized and received in addition to hypoglycemic therapy injections of bemiparin at a dose 2500 IU/day for 18–24 days. Patients from the control with compensated diabetes mellitus, who were on outpatient treatment, received only hypoglycemic therapy. All patients underwent three percutaneous measurement of oxygen partial pressure on the dorsum of the foot (PtcO2): before treatment, at the end of the course of bemiparin introduction (18th day) and at the end of the 5th week of treatment. According to research results, the mean PtcO2 value in the control group before treatment was 34.64 ± 3.38 mmHg, after 18 days — 34.29 ± 4.25 mmHg, and at the end of the 5th week of treatment — 34.31 ± 3.74 mmHg. In the study group, this figure was an average of 31.32 ± 4.56 mmHg, 39.88 ± 5.89 mmHg and 37.45 ± 4.51 mmHg, respectively. There was a statistically significant positive growth dynamics of PtcO2 in patients of the study group on the 18th day and on the 5th week in comparison with baseline (p < 0.01). Differences in PtcO2 growth in favor of the study group compared with the control one at the end of bemiparin therapy were also statistically significant (p < 0.01), although in 5–6 weeks intergroup differences lost significance (p = 0.058). Thus, according to research results, the use of bemiparin significantly improves tissue trophism of the lower limbs in patients with diabetic peripheral neuropathy, which, in turn, promotes the healing of diabetic foot ulcers.

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References

Davies M., Brophy S., Williams R., Taylor A. The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes // Diabetes Care. — 2006. — Vol. 29. — P. 1518-1522.

Boulton A.J., Vileikyte L., Ragnarson-Tennvall G., Apelqvist J. The global burden of diabetic foot disease // Lancet. — 2005. — Vol. 366. — P. 1719-1724.

Reiber G.E., Boyko E.J., Smith D.G. Lower extremity foot ulcers and amputations in diabetes // National Diabetes Data Group (U.S.). Diabetes in America. — 2nd ed. — Bethesda, Md.: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, USA; 1995; NIH publication no. 95-1468.

Pham H.T., Economides P.A., Veves A. The role of endothelial function on the foot. Microcirculation and wound healing in patients with diabetes // Clin. Podiatr. Med. Surg. — 1998. — Vol. 15. — P. 85-93.

Vinik A.I., Erbas T., Park T.S. et al. Platelet dysfunction in type 2 diabetes // Diabetes Care. — 2001. — Vol. 24. — P. 1476-1485.

Ceriello A. Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects // Diabetologia. — 1993. — Vol. 36. — P. 1119-1125.

Lapolla A., Piarulli F., Sartore G. et al. Peripheral artery diseases in type 2 diabetes: the role of fibrinolysis // Thromb. Haemost. — 2003. — Vol. 89. — P. 91-96.

Gershater M.A., Lцndahl M., Nyberg P. et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study // Diabetologia. — 2009. — Vol. 52, № 3. — P. 398-407.

Таран Є.В., Бабіна Г.В., Горобейко М.Б. та ін. Парціальний тиск кисню у шкірі стоп хворих на цукровий діабет, ускладений периферичною нейропатією та мікроангіопатією // Клінічна ендокринологія та ендокринна хірургія. — 2007 . — № 1(18). — С. 49-50.

Міжнародна угода з проблеми діабетичної стопи. — К., 2004. — 96 с.

Nader H.B., Buonassisi V., Colburn P., Dietrich C.P. Heparin stimulates the synthesis and modifies the sulfation pattern of heparansulfate proteoglycan from endothelial cells // J. Cell. Physiol. — 1989. — Vol. 140. — P. 305-310.

Hehenberger K., Kratz G., Hansson A., Brismar K. Fibroblasts derived from human chronic diabetic wound shave a decreased proliferation rate, which is recovered by the addition of heparin // J. Dermatol. Sci. — 1998. — Vol. 162. — P. 144-151.

Artico M., Massa R., Cavalotti D. et al. Morphological changes in the sciatic nerve of diabetic rats treated with low molecular weight heparin OP 2123/parnaparin // Anat. Histol. Embryol. — 2000. — Vol. 31. — P. 193-197.

Kalani M., Apelqvist J., Blombдck M. et al. Effect of dalteparin on healing of chronic foot ulcers in diabetic patients with peripheral arterial occlusive disease // Diabetes Care. — 2003. — Vol. 26. — P. 2575-2580.

Rullan M., Cerdа L., Frontera G., Llobera J. Diabetic foot ulcers and treatment with low molecular weight heparin // Med. Clin. (Barc.). — 2002. — Vol. 118. — P. 757.

Planes A. Review of bemiparinsodium-a new second-generation low molecular weight heparin and its applications in venous thromboembolism // Expert. Opin. Pharmacother. — 2003. — Vol. 4. — P. 1551-1561.

Rullan M., Cerdа L., Frontera G. et al. Treatment of chronic diabetic foot ulcers with bemiparin: A randomised, triple-blind, placebocontrolled, clinical trial // Diabet. Med. — 2008. — Vol. 25 (9). — P. 1090-1095.

Горобейко М.Б., Гирявенко О.Я. Класифікація діабетичної стопи, затверджена Міжнародною робочою групою з діабетичної стопи IDF і ВООЗ // Клінічна ендокринологія та ендокринна хірургія. — 2004 — № 1(6). — С. 83-86.

Published

2022-02-18

How to Cite

Gorobeiko, M. (2022). Anticoagulation Therapy with Bemiparin in Combination Treatment of Patients with Diabetic Peripheral Neuropathy and Latent Ischemia of Lower Limb Tissues. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), (5.61), 18–21. https://doi.org/10.22141/2224-0721.5.61.2014.76845

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Section

Original Researches