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Identify and Treat the Cause - Medical Therapy: Pharmacological Treatment


Pentoxyfilline (Trental)1

  • It is a haemorheological agent, thought to increase red and white cell filterability by altering the shape and flexibility and therefore the flow of cells, and decrease whole blood viscosity, platelet aggregation and fibrinogen levels2
  • Influences microcirculatory blood flow and oxygenation of ischaemic tissues
  • The full product monograph should be consulted re: precautions when using with anticoagulants such as Plavix, as Trental may increase the risk of bleeding
  • In a Cochrane review of 11 randomised trials comparing Pentoxifylline with placebo or other therapy in the presence or absence of compression, in people with venous leg ulcers, Pentoxifylline was seen to be an effective adjunct to compression bandaging for treating venous ulcers and may be effective in the absence of compression3
  • The majority of adverse effects were gastrointestinal disturbances
  • If woody fibrosis and induration are present in the peri-wound area or in the leg, Pentoxyfilline (Trental) 400mg TID helps to soften fibrosis and allows the wound to heal.
  • Start with a BID dosage and increase to TID as tolerated, with appropriate precautions with individuals with known history of indigestion or GERDs.
  • Be aware that it may take two months before benefit can be seen

Phlebotonics

  • Phlebotonics are a class of drugs that are often used to treat cardiovascular insuffiency
  • These are natural flavonoids extracted from plants and similar synthetic products (e.g. french maritime pine bark extract, grape seed extract and aminaftone)
  • In a Cochrane review in 2005, there was not enough evidence to globally support the efficacy of phlebotonics for chronic venous insufficiency4
  • There is a suggestion of some efficacy of phlebotonics on oedema but this is of uncertain clinical relevance5
Identify and Treat the Cause - Surgical Interventions
  1. Sanofi Aventis, www.sanofi.ca/products/en/trental.pdf
  2. Lee, Y. Robinson, M. et al. Diabetes Complications. The Effect of Pentoxifylline on Current Perception Thresholds in Patients with Diabetic Neuropathy. 1997. Sep-Oct; 11(5):274-8
  3. Jull AB, Arroll B et al. Pentoxifylline for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.:CD001733. Doi:10.1002/14651858.CD001733.pub2
  4. Jull AB, Arroll B et al. Pentoxifylline for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.:CD001733. Doi:10.1002/14651858.CD001733.pub2
  5. Lee, Y. Robinson, M. et al. Diabetes Complications. The Effect of Pentoxifylline on Current Perception Thresholds in Patients with Diabetic Neuropathy. 1997. Sep-Oct; 11(5):274-8

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