ArticlesPentoxifylline for treatment of venous leg ulcers: a systematic review
Introduction
Most leg ulcers are venous.1 High compression treatment (three-layer or four-layer short-stretch bandaging, or Unna boot) is an effective cure for venous ulcers,2 but despite compression, almost 30% of people remain unhealed after 1 year of treatment.3 Adjuvants to compression treatment could be beneficial. Pentoxifylline, a haemorrheological agent, reduces the viscosity of blood by increasing the flexibility of erythrocytes, encouraging migration of white cells, inhibition of aggregation of platelets, and lowering of the viscosity of plasma,4 actions that might correct microcirculatory disorders. Trials5, 6 of the clinical effectiveness of pentoxifylline have had conflicting results, and the usefulness of the drug remains unclear.7 We therefore systematically reviewed randomised controlled trials to quantify the effect of pentoxifylline (Trental, Aventis Pharma, Lyon, France) on healing in venous leg ulcers, either as an adjuvant to compression, or compared with placebo.
Section snippets
Methods
We searched the CENTRAL registers of the Cochrane Wounds Group and the Cochrane Peripheral Vascular Diseases Group to September, 2000. We identified no new controlled trials in our search of the Wound Review Group register to April, 2001. The CENTRAL registers differ from the Cochrane Controlled Trials Register in that they contain references that have not been confirmed as controlled trials, or trials that have not yet been forwarded for inclusion in the Cochrane register. The register of the
Results
We included eight trials (table 2),5, 6, 8, 9, 10, 11, 12, 13 two of which were not written in English.11, 12 In most studies, the primary outcome was either complete healing of the patients' reference ulcer (usually the largest ulcer) or of all ulcers on the reference leg,5, 6, 9 or data was provided for individual patients, from which we could calculate the number of patients healed.11, 12 In one trial,10 data were presented in a life table, from which the number of patients healed was
Discussion
Our results showed that pentoxifylline improves healing rates compared with placebo. Pentoxifylline was effective for treatment of leg ulcers, but the evidence for pentoxifylline on it's own is not as strong as that for this drug as an adjuvant to compression treatment. The finding is stronger in trials that lasted longer than 12 weeks, although this result could be because the longer trials were of better quality than the shorter trials.
Although which microcirculatory events link venous
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