Brief reportIncreased incidence of hypercoagulability in patients with leg ulcers caused by leukocytoclastic vasculitis☆
Section snippets
Patients and methods
Since 1999, all new consecutive patients that were admitted to the hospital (Department of Dermatology, Academic Medical Center, Amsterdam) for skin ulcers caused by vasculitis were included in the study. In all patients, the diagnosis “vasculitis ulcer” was already suspected at the moment of hospital admission because of clinical signs suggestive for vasculitis (usually multiple ulcerations, presence of black necrotic tissue, irregular borders, purple discoloration at the margins (Fig 1), or
Results
In total, 13 consecutive patients (all white, 5 male, 8 female, mean age 63 years) were included in the study. Most of them (85%) had multiple ulcers (mean: 5.3 ulcers). The average total wound size was 75 cm2, the average duration of the ulcers at time of admittance was 5.6 months, and the average duration from first onset to total healing was 8.5 months.
Discussion
Hypercoagulable disorders were found in 7 of 13 (53%) patients with leg ulcers caused by leukocytoclastic vasculitis. Five of them had factor V Leiden (38%). The normal frequency of factor V Leiden in the European population is estimated to be 5% to 6%.12
We hypothesize that the following sequence of events is taking place. In vasculitis, the vascular wall is damaged. The vascular damage initiates the coagulation cascade, prothrombin is converted to thrombin, and thrombin activates factor V and
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Hypercoagulation and autoimmunity
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2013, Revue de Medecine InterneNecrotic leg ulcers induced by vitamin K antagonists: Five cases
2011, Annales de Dermatologie et de VenereologieThe vasculopathic reaction pattern
2009, Weedon's Skin Pathology: Third EditionCutaneous vasculitis: diagnosis and management
2006, Clinics in DermatologyWounds caused by vasculitis—Current classification, diagnostics and treatment
2023, Zeitschrift fur Gerontologie und Geriatrie
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Funding sources: None.
Conflict of interest: None identified.