Prognostic indicators in venous ulcers

Background: Venous ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. Objective: The objective of this study was to analyze the results of a larg e multicenter venous deer trial to retrospectively establish prognostic fac tors for venous ulcer healing. Methods: This study examined data from a previously published prospective r andomized placebo-controlled trial of an oral medication versus placebo tre atment for venous ulcers. Local leg ulcer care involved the use of a moistu re-retentive dressing and sustained graduated compression with a paste band age and a self-adherent wrap. The oral medication or placebo was administer ed on a daily basis with the same dressings and bandage system in both grou ps for 12 weeks. A total of 165 patients completed the full 12-week treatme nt period; 83 received ifetroban, 82 received placebo. Results: There was no statistically significant difference in outcome betwe en the two groups. The study showed that consistent local ulcer treatment w ith a clearly defined system of care was associated with an unexpectedly hi gh percentage (55%) of long-standing large venous ulcers (mean duration, 27 months; mean area, 15.9 cm(2)) being healed in both groups. Baseline ulcer area and duration of leg ulcer were found to be important in predicting ou tcome. Ulcers of short duration were found to be most,likely to heal. Perce nt healing and ulcer area at week 3 were good predictors of 100% healing. U lcers that had at least 40% healing by week 3 predicted more than 70% of th e outcomes correctly Conclusion: From this large study it was determined that baseline ulcer are a and ulcer duration are significant predictors of 100% healing and time to heal. Percent healing and ulcer area at week 3 are good predictors of comp lete ulcer healing. Ulcers that are large, long-standing and slow to heal a fter 3 weeks of optimal therapy are unlikely to heal rapidly, and might ben efit from alternative therapies.