Effectiveness of Actovegin at Peripheral Angiopathy of Different Stages in Patients with Diabetes Mellitus
There was assessed the effectiveness of Actovegin use at peripheral angiopathy of different stages in patients with diabetes mellitus. The assessment was carried out on principles of evidence-based medicine, using PEDIS classification. Levels of ТсРО2 were studied in patients with critical, non-critical ischemia and in control group, as well as dynamics of lower-extremity ulcers repair in patients before treatment, in 10, 45 days, 3 and 6 months and after second course of treatment. Actovegin was prescribed intravenously 2000 mg once daily during 12 days, then orally 600 mg daily up to 45 days. 39 patients were enrolled in the study, they received 2 courses of treatment, and control group — 11 patients. Treatment with Actovegin have shown efficacy in patients with diabetic foot syndrome with non-critical lower-limb ischemia: oxygen partial pressure significantly increased in lower-limb tissues both at first and second course of treatment: 35.70 ± 4,31 mmHg to 39.77 ± 8,22 mmHg in controls; 35.58 ± ± 6.91 mmHg to 42.37±6.22 mmHg after first course of treatment and from 36.28 ± 5.23 mmHg to 47.11 ± 6.21 mmHg after second course of treatment. This leads by-turn to more fast ulcer repair as compared to control group (p < 0.05 between controls and investigation groups). Secondary course of treatment with Actovegin significantly increased the number of repaired ulcers (after first course of treatment constant regeneration was observed in 19 (48.7 %) patients, after second course of treatment ulcers repaired in 8 patients, active epithelialization was observed in 6 patients, it means that effect of refresher course of treatment in relation to regeneration is 84.6 %). Even after decrease of oxygen partial pressure in tissues in Actovegin group there was remained positive effect in relation to wound healing and reduction of relapses number. There was defined the significant increase of ТсРО2 in patients managed with Actovegin in group of non-critical ischemia from 10th day from initiation of treatment with retention of statistically significant effect within 3 months. Long-term effect (up 6 months) for wound healing had been proved. The efficacy of Actovegin in combined treatment of patients with critical lower-limb ischemia was defined.