Pressure tactics

Venous leg ulcers can be difficult to heal, despite the use of measures such as compression bandaging. In addition, some patients might not be eligible for compression therapy due to other medical conditions (eg, arterial insufficiency). Pentoxifylline, a drug that improves blood flow, has been used in the treatment of venous leg ulcers. But is it effective?

A recent Cochrane update reviewed randomized trials up to February 2007, comparing pentoxifylline with placebo or other therapy, in the presence or absence of compression, among people with venous leg ulcers. The reviewers analyzed the results of 12 trials involving 864 participants.

Eleven trials compared pentoxifylline with placebo or no treatment. In 7 of these studies, the patients also received compression therapy. The quality of the trials was variable. In particular, the sample populations were quite heterogenous (hard-to-heal versus “normal” healing).

The researchers found that pentoxifylline plus compression was more effective than placebo plus compression (relative risk 1.56, 95% confidence interval 1.14 to 2.13). If no compression was used, pentoxifylline appeared to be more effective than placebo or no treatment (relative risk 2.25, 95% CI 1.49 to 3.39). More adverse effects were reported among those receiving pentoxifylline, and most of these effects were gastrointestinal.

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