VASOSPASM IN PATIENTS WITH INTERMITTENT CLAUDICATION - EFFECTS OF DEFIBROTIDE AND ACETYLSALICYLIC-ACID

In patients with claudication, platelets aggregating on the altered ar terial wall release vasoactive substances that cause vasoconstriction. The importance of vasospasm due to platelet deposition may be demonst rated by laser Doppler flowmetry. In this study, 19 patients with inte rmittent claudication were randomized to receive acetylsalicylic acid (100 mg daily), defibrotide (400 mg twice daily), the two-drug combina tion, or placebo. No changes in the microcirculation or in walking dis tance were observed in the placebo (control) group. In the 10 patients who received active treatment, skin blood flow and venoarteriolar res ponse increased, indicating a decreased level of vasospasm. The effect of the combined treatment was significantly greater than that of eith er monotherapy. Pain-free and total walking distances increased propor tionally to the improvement in microcirculatory parameters, with a mor e relevant increase produced by the combination treatment. No side eff ects were recorded and no patients dropped out of the study. Acetylsal icylic acid and defibrotide are effective in reducing vasospasm in pat ients with claudication, possibly by reducing platelet aggregation and fibrin deposition. The interaction of the two drugs positively affect s signs, symptoms, and the microcirculation.