A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers
| Autor: | Rim Hasan, Larry J. Prokop, Apostolos Tsapas, Anil Hingorani, Mohammad Hassan Murad, Gabriela Prutsky, Tarig Elraiyah, Juan Pablo Domecq, Paul L. Claus, Lawrence W. Steinkraus, Belal Firwana, Mohammed Nabhan |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Vasodilator Agents Tetrazoles 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Placebo Pentoxifylline/therapeutic use law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans purl.org/pe-repo/ocde/ford#3.02.04 [https] Iloprost Pentoxifylline Aged Diabetic Foot/drug therapy/therapy Hyperbaric Oxygenation business.industry Odds ratio Middle Aged medicine.disease Diabetic foot Diabetic Foot Surgery Cilostazol Diabetic foot ulcer Treatment Outcome Amputation Meta-analysis Tetrazoles/therapeutic use Vasodilator Agents/therapeutic use purl.org/pe-repo/ocde/ford#3.02.11 [https] Female Cardiology and Cardiovascular Medicine business Iloprost/therapeutic use medicine.drug |
| Zdroj: | Journal of vascular surgery. 63 |
| ISSN: | 1097-6809 |
| Popis: | BACKGROUND: Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. RESULTS: We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. CONCLUSIONS: There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions. |
| Databáze: | OpenAIRE |
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