rivaroxaban and Livedo-Reticularis

Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing.. The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well-defined patient cohort.. The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV.. Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female-to-male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5-68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56-70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti-inflammatory regimens were, although often used (17/24), not effective (0/17).. We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012-000108-13-DE).

Topics: Adult; Aged; Factor Xa Inhibitors; Female; Humans; Livedo Reticularis; Male; Middle Aged; Prospective Studies; Risk Factors; Rivaroxaban

Topics: Humans; Livedo Reticularis; Livedoid Vasculopathy; Retrospective Studies; Rivaroxaban

Topics: Adolescent; Adult; Aged; Child; Factor Xa Inhibitors; Female; Humans; Livedo Reticularis; Male; Middle Aged; Republic of Korea; Retrospective Studies; Rivaroxaban

Topics: Administration, Oral; Anticoagulants; Dermatology; Factor Xa Inhibitors; Female; Humans; Livedo Reticularis; Middle Aged; Rivaroxaban

Livedoid vasculopathy (LV) is a thrombotic skin disease characterized by episodic painful ulcerations of the distal aspects of the legs. Its healing process typically leaves small porcelain-white scars called atrophie blanche as a result of the occlusion of cutaneous microcirculation. The main goals of the treatment are pain management and the prevention of ulceration and of progressive scarring in the malleolar area. The therapeutic management is still a challenge, however, and most treatments were based on anecdotal off-label protocols. Over such context, direct oral anticoagulants (DOACS) arise as a potential treatment for this disease. This class of medications became an alternative from initial large studies applied on different pathologic scenarios regarding thromboembolic events. In that line, recent case series using DOACS, including rivaroxaban, started to emerge in the literature related to LV and reported successful prevention of cutaneous infarctions and ulcerations, providing physicians with a new promising alternative. The current report describes four cases of long-term recalcitrant LV, in which rivaroxaban monotherapy effectively reduced pain and cutaneous ulcerations in a few weeks of treatment without relevant side effects. The authors also review therapy management of the disease, focused on DOACS, and suggest a step-by-step approach to treat these patients, taking into consideration different resource profiles of each level of local health centers, the gravity of the cases, and risks/benefits for patients.

Topics: Administration, Oral; Adult; Anticoagulants; Disease Management; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Foot Ulcer; Humans; Livedo Reticularis; Middle Aged; Rivaroxaban; Sampling Studies; Severity of Illness Index; Treatment Outcome; Wound Healing

Topics: Drug Administration Schedule; Factor Xa Inhibitors; Humans; Livedo Reticularis; Male; Middle Aged; Rivaroxaban

Topics: Adult; Aerospace Medicine; Collateral Circulation; Combined Modality Therapy; Edema; Emergencies; Female; Heparin; Humans; Leg; Livedo Reticularis; Low Back Pain; Mobility Limitation; Phlebography; Rivaroxaban; Stockings, Compression; Tachycardia, Sinus; Thrombectomy; Thrombolytic Therapy; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Ultrasonography, Doppler; Vena Cava, Inferior; Venous Thrombosis

Topics: Adolescent; Anticoagulants; Capillaries; Chronic Disease; Factor Xa Inhibitors; Female; Humans; Infarction; Livedo Reticularis; Morpholines; Rivaroxaban; Skin; Thiophenes; Young Adult