anticoagulation therapy with bemiparin in combination treatment of patients with diabetic peripheral neuropathy and latent ischemia of lower limb tissues

It is known that diabetic peripheral neuropathy as well as microangiopathy increases risk of diabetic foot syndrome development even with preserved patency of main arteries of the lower limbs. In this paper we examined the efficacy of anticoagulation therapy using low molecular weight heparin of second generation — bemiparin in combination treatment of patients with diabetic peripheral neuropathy with latent feet ischemia. The study included 48 patients with diabetes mellitus type 2 and instrumentally confirmed diabetic peripheral neuropathy without occlusion of main arteries of the lower limbs. Of these, 34 were main group, 14 — control one. Patients of the study group were hospitalized and received in addition to hypoglycemic therapy injections of bemiparin at a dose 2500 IU/day for 18–24 days. Patients from the control with compensated diabetes mellitus, who were on outpatient treatment, received only hypoglycemic therapy. All patients underwent three percutaneous measurement of oxygen partial pressure on the dorsum of the foot (PtcO2): before treatment, at the end of the course of bemiparin introduction (18th day) and at the end of the 5th week of treatment. According to research results, the mean PtcO2 value in the control group before treatment was 34.64 ± 3.38 mmHg, after 18 days — 34.29 ± 4.25 mmHg, and at the end of the 5th week of treatment — 34.31 ± 3.74 mmHg. In the study group, this figure was an average of 31.32 ± 4.56 mmHg, 39.88 ± 5.89 mmHg and 37.45 ± 4.51 mmHg, respectively. There was a statistically significant positive growth dynamics of PtcO2 in patients of the study group on the 18th day and on the 5th week in comparison with baseline (p < 0.01). Differences in PtcO2 growth in favor of the study group compared with the control one at the end of bemiparin therapy were also statistically significant (p < 0.01), although in 5–6 weeks intergroup differences lost significance (p = 0.058). Thus, according to research results, the use of bemiparin significantly improves tissue trophism of the lower limbs in patients with diabetic peripheral neuropathy, which, in turn, promotes the healing of diabetic foot ulcers.