Effects of Flunarizine and Pentoxifylline on Walking Distance and Blood Rheology in Claudication

Perhoniemi, Vesa; Salmenkivi, K; Sundberg, Stig; Johnsson, Riitta; Gordin, A.

doi:10.1177/000331978403500605

Cited by 37 publications

(10 citation statements)

References 20 publications

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“…From all the reports 17 double-blind, placebo-controlled studies were available for review. 28,43,[49][50][51][52][53][54][55][56][57][58][59][60][61][62] The original studies were obtained and studied. Two drug information pharmacists working in the statewide drug information service independently evaluated the studies.…”

Section: Methodsmentioning

confidence: 99%

The Trials and Tribulations of Pentoxifylline

Effeney¹,

Stokes²,

Trenerry³

1992

Perspectives in Vascular Surgery and Endovascular Therapy

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The syndrome of intermittent claudication is the most common reason a patient with atherosclerosis of the abdominal aorta, its iliac branches or leg arteries, presents for an opinion about therapy. The prevalence of this syndrome is approximately 1.5% to 6% in menl2 and slightly less than 2% in women.3 The Framingham study data suggest a 2:1 male-female ratio at presentation.' The rate of presentation increases with age up to 75 years, after which the incidence rate levels off.Intermittent claudication has a favorable prognosis in terms of limb salvage. Only 5% to 6% of the claudicant population progress to ischemia severe enough to require amputation within 5 years of presentation.5-' Claudication is, however, an important predictor of the presence of atherosclerosis in other vascular beds. It is a marker of increased cardiovascular mortality.8-10 Despite the increased mortality ratios for both men and women, 70% to 80% of claudicants survive 5 years, 40% survive 10 years, and 26% are still alive 15 years after first presentations. 11,12 The diagnosis of atherosclerotic involvement of the lower extremity can be made with great accuracy on clinical grounds. 13 The features of pain, heaviness, and tiredness or fatigue in the muscles of the lower extremity brought on by walking, relieved by rest, and occurring again after walking the same distance are the key elements in the history. The claudication distance is an accurate indicator of the severity of the problem and is indicative of the number of levels of the arterial tree that are involved. Physical examination reveals the absence of pulses or their quality when present. The sites of flow disturbance may be detected by the presence of a bruit along the vessel. The state of the skin is an accurate reflection of nutritive blood flow in patients with more advanced atherosclerosis.The simple o~ce test of Doppler-derived ankle blood pressures allows quantification by means of the ankle / brachial systolic pressure index and excludes almost all cases of pseudoclaudication.

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Section: Methodsmentioning

confidence: 99%

The Trials and Tribulations of Pentoxifylline

Effeney¹,

Stokes²,

Trenerry³

1992

Perspectives in Vascular Surgery and Endovascular Therapy

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“…The clinical trials evaluating the use of pentoxifylline do not consistently demonstrate a benefit in PFWD or MWD when compared with placebo ( Table 3). [80][81][82][83][84][85][86][87][88][89][90][91][92][93] These trials vary in sample size (< 50 patients in half of the trials), follow-up time (2-12 mo), dosage (600-1600 mg/day), patient baseline characteristics, and route of administration, with at least two that evaluated an intravenous formulation. There is also There are only four trials of pentoxifylline 400 mg 3 times/day in which more than 100 patients were randomized.…”

Section: Pentoxifyllinementioning

confidence: 99%

Pharmacologic Therapy for Intermittent Claudication

2009

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Peripheral artery disease, defined as atherosclerosis in the lower extremities, affects nearly 8.5 million people in the United States. Due to the frequent asymptomatic manifestation of peripheral artery disease, diagnosis may be delayed and its true incidence underestimated. However, some patients may experience aching pain, numbness, weakness, or fatigue, a condition termed intermittent claudication. Peripheral atherosclerosis is associated with cardiovascular risk and physical impairment; therefore, treatment goals are aimed at decreasing cardiovascular risk, as well as improving quality of life. Little debate exists regarding the management of cardiovascular risk reduction, which consists of both antiplatelet therapy and risk factor modification. Despite recently published guidelines, the treatment of intermittent claudication is less well established and the management remains controversial and uncertain. Exercise remains the first-line therapy for intermittent claudication; however, pharmacologic treatment is often necessary. Although only two prescription drugs have been approved by the U.S. Food and Drug Administration for the treatment of intermittent claudication, several supplements and investigational agents have been evaluated. Therapeutic optimization should balance the anticipated improvements in quality of life with the potential safety risks.

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“…The widespread atherosclerotic involvement of the arterial tree often does not allow a surgical approach, which appears suitable only in those patients with very localized lesions involving large arterial branches, and sometimes, even in these selected patients, this approach is unsatis factory. 2,3 In recent reports 4,1 increased blood viscosity and platelet hyperaggregability have been demonstrated in these patients, justifying the good results obtained with pentoxifylline, 6,7,8,9 whereas the efficacy of vasodilators and anticoagulants agents has not so far been clearly demonstrated. '°-'2 Interesting results have been obtained with buflomedil13 and by the intraarterial administration of prostacycline, 14,15 although this latter procedure cannot be used in general clinical practice.…”

Section: Introductionmentioning

confidence: 98%

Improvement of Walking Distance in Patients with Intermittent Claudication by Chronic Local Therapy with Isosorbide Dinitrate Ointment

et al. 1988

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Isosorbide dinitrate ointment (100 mg tid) was directly applied to 30 male patients with stable, documented intermittent claudication on the areas where ischemic pain was experienced. The symptom-free distance walked (DWA) and the maximum distance reached (MDR) basally, after one, three, six, and twelve months were evaluated by means of treadmill stress tests (TSTs) (angle 0 degree-velocity constant/patient). After the basal TST, patients were randomly divided into two groups: placebo group and therapy group (double blind), and a further TST was administered one month later. DWA results were 74 +/- 8 m vs 297 +/- 83 m and MDR results were 163 +/- 22 m vs 506 +/- 86 m in the therapy group (basal vs one month TST: p less than .01) and 94 +/- 24 m vs 96 +/- 15 m and 232 +/- 53 m vs 183 +/- 26 m in the placebo group, respectively (basal vs one month TST: NS). Being confident that a significant placebo effect was absent, the authors opened the trial and treated all patients, repeating further TSTs at three, six, and twelve months. The following results were obtained: DWA was 84 +/- 13 m, 316 +/- 63 m, 374 +/- 55 m, and 452 +/- 61 m; and MDR was 197 +/- 29 m, 431 +/- 59 m, 514 +/- 57 m, and 547 +/- 59 m, respectively, in basal conditions and after three, six, and twelve months of treatment (p less than .01 for all the values for both DWA and MDR vs basal values).(ABSTRACT TRUNCATED AT 250 WORDS)

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Effects of Flunarizine and Pentoxifylline on Walking Distance and Blood Rheology in Claudication

Cited by 37 publications

References 20 publications

The Trials and Tribulations of Pentoxifylline

The Trials and Tribulations of Pentoxifylline

Pharmacologic Therapy for Intermittent Claudication

Improvement of Walking Distance in Patients with Intermittent Claudication by Chronic Local Therapy with Isosorbide Dinitrate Ointment

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