Bissacco Daniele, Pisani Chiara, Avallone Gianraffaele, D'Alessio Ilenia
Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.
School of Vascular Surgery, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.
J Clin Med. 2025 Mar 10;14(6):1859. doi: 10.3390/jcm14061859.
: Although considerable data are available on oral venoactive drugs, very little information has been published on the types and outcomes of topical treatments for venous disease (VD). This comprehensive review assesses the efficacy and safety of topical heparin and heparinoid-containing products (HCPs) for VD treatment. : This narrative review adhered to established methodologies and standards, utilizing the Scale for the Assessment of Narrative Review Articles (SANRA) for quality assessment. A comprehensive literature search was conducted across MEDLINE (PubMed), Scopus, and Web of Science, covering publications from January 1, 1950, to December 1, 2024. Findings were presented in a narrative format, following structured recommendations to ensure clarity and coherence. : Topical heparin and HCPs provide anticoagulation, enhance microcirculation, and regulate skin permeability, with effects influenced by the concentration and formulation. While they effectively improve skin microcirculation in healthy individuals, research on their intracellular effects is limited. Mucopolysaccharide polysulfate (MPS) in heparinoids offers similar vascular benefits and promotes antithrombotic and anti-inflammatory actions. Moisture and gentle abrasion enhance heparin absorption. Topical heparin and HCPs effectively treat superficial vein thrombosis (SVT) and varicose veins (VVs). Products like Hirudoid significantly alleviate SVT symptoms, including pain and swelling. Clinical trials demonstrate substantial symptom improvement with heparin gel (1000 IU/g). For varicose veins, Xioglican cream stabilizes symptoms and improves quality of life, while other formulations like Essaven Gel and Venoruton enhance microcirculation. : Managing VD with topical treatments is complicated by the outdated literature and inconsistent methodologies. There is a clear need for systematic research to establish guidelines on the administration, dosage, and frequency of topical treatments. The recommendations in this review aim to provide a foundation for future studies to improve the management of SVT and VVs disease.
尽管有大量关于口服血管活性药物的数据，但关于静脉疾病（VD）局部治疗的类型和结果的信息却很少发表。本综述全面评估了局部肝素和含类肝素产品（HCPs）治疗VD的疗效和安全性。：本叙述性综述遵循既定的方法和标准，使用叙述性综述文章评估量表（SANRA）进行质量评估。在MEDLINE（PubMed）、Scopus和Web of Science上进行了全面的文献检索，涵盖1950年1月1日至2024年12月1日的出版物。研究结果以叙述形式呈现，遵循结构化建议以确保清晰连贯。：局部肝素和HCPs具有抗凝作用，可增强微循环并调节皮肤通透性，其效果受浓度和制剂影响。虽然它们能有效改善健康个体的皮肤微循环，但对其细胞内作用的研究有限。类肝素中的硫酸黏多糖（MPS）具有类似的血管益处，并促进抗血栓和抗炎作用。湿润和轻柔摩擦可增强肝素吸收。局部肝素和HCPs可有效治疗浅静脉血栓形成（SVT）和静脉曲张（VVs）。喜疗妥等产品可显著缓解SVT症状，包括疼痛和肿胀。临床试验表明肝素凝胶（1000 IU/g）可显著改善症状。对于静脉曲张，消脱止乳膏可稳定症状并改善生活质量，而爱脉朗凝胶和维脑路通等其他制剂可增强微循环。：由于文献陈旧和方法不一致，用局部治疗管理VD很复杂。显然需要进行系统研究以建立关于局部治疗的给药、剂量和频率的指南。本综述中的建议旨在为未来研究提供基础，以改善SVT和VVs疾病的管理。
