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Identify and Treat the Cause - Pharmacological Treatment


Pentoxyfilline (Trental)1 2

  • 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 levels3
  • Influences microcirculatory blood flow and oxygenation of ischaemic tissues
  • May increase blood flow for patients with vasospastic disorders such as Raynaud phenomenon
  • Would have very little effect in advanced peripheral arterial disease
  • 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 arterial ulcers and may be effective in the absence of compression4
  • 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

Nifedipine5

  • May increase blood flow for patients with vasospastic disorders such as Raynaud phenomenon

Surgical and Medical Intervention Strategies
  1. Weir G.R, Hiske S, Marle J.V, Cronje F.J, Sibbald R.G. Arterial Disease Ulcers, Part 2: Treatment. Advances in Skin and Wound Care: September 2014.
  2. Sanofi Aventis, www.sanofi.ca/products/en/trental.pdf.
  3. Jahromi Afshin, Vascular Surgeon, Guelph General Hospital 2015.
  4. Despatis,M.,Shapera,L.,Parslow,N.Woo,K.(2008) Complex Wounds Wound Care Canada 8(2):24‐25.
  5. Weir G.R, Hiske S, Marle J.V, Cronje F.J, Sibbald R.G. Arterial Disease Ulcers, Part 2: Treatment. Advances in Skin and Wound Care: September 2014.

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