Examining risk factors and preventive treatments for first venous leg ulceration: A cohort study - 26/02/20

Doi : 10.1016/j.jaad.2019.12.046

Evan Darwin, MD ^a, Guodong Liu, PhD ^b, Robert S. Kirsner, MD, PhD ^a, Hadar Lev-Tov, MD ^a,^⁎
^a Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
^b Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania

^∗Correspondence to: Hadar Lev-Tov, MD, 1600 NW 10th Ave RMSB 2023, Miami, FL 33136.1600 NW 10th Ave RMSB 2023MiamiFL33136

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Abstract

Background

Large studies that examine risk factors for first occurrence of venous leg ulcerations are needed to guide management.

Objective

To investigate factors associated with development of first occurrence of venous leg ulcerations.

Methods

A retrospective cohort study using a validated national commercial claims database of patients with venous insufficiency. Subjects were followed to determine whether they developed first occurrence of venous leg ulcerations, and risk and protective factors were analyzed.

Results

Adjusted hazard ratio (AHR) for comorbidities demonstrated an increased risk in men (AHR 1.838; 95% confidence interval [CI] 1.798-1.880), older age (45-54 years: AHR 1.316, 95% CI 1.276-1.358; 55-64 years, AHR 1.596, 95% CI 1.546-1.648), history of nonvenous leg ulceration (AHR 3.923; 95% CI 3.699-4.161), anticoagulant use (AHR 1.199; 95% CI 1.152-1.249), antihypertensive use (AHR 1.067; 95% CI 1.040-1.093), and preexisting venous insufficiency including chronic venous insufficiency (AHR 1.244; 95% CI 1.193-1.298), edema (AHR 1.224; 95% CI 1.193-1.256), and chronic venous hypertension (AHR 1.671; 95% CI 1.440-1.939). Possible protective factors were having venous surgery (AHR 0.454; 95% CI 0.442-0.467), using compression stockings (AHR 0.728; 95% CI 0.705-0.753), using prescribed statin medications (AHR 0.721; 95% CI 0.700-0.743), and using pain medications (AHR 0.779; 95% CI 0.757-0.777).

Limitations

Risk of misclassification, given the use of International Classification of Diseases, Ninth Revision codes. Possible confounding factors such as body mass index could not be adequately controlled with these codes.

Conclusion

The new evidence presented supports a paradigm shift toward venous leg ulceration prevention.

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Key words : venous leg ulcer, prevention, venous insufficiency, chronic venous insufficiency, venous surgery, wounds, chronic wounds, first venous leg ulcer

Abbreviations used : AHR, CI, fVLU, ICD-9, SD, VI, VLU

Plan

Risk and protective factors

Time to event analysis

Strengths and limitations

Conclusions

	Funding sources: Supported by a Dermatology Foundation and University of Miami award to Dr Lev-Tov.
	Conflicts of interest: None disclosed.
	The sponsors had no role in the study design.
	IRB approval status: Not applicable.