Treatment outcomes in patients of livedoid vasculopathy following antithrombotic therapy: A retrospective observational study

Background Livedoid vasculopathy, characterised by painful ulcers and atrophie blanche, significantly affects the quality of life of patients. Data pertaining to the efficacy of various available treatment options for this condition is limited, especially in India. Aim The study aimed to evaluate the treatment outcomes, clinicodemographic features, and associated laboratory abnormalities in patients with livedoid vasculopathy at a tertiary care centre. Methods This retrospective observational study analysed the case records and clinical photos of all clinically and histologically proven cases of livedoid vasculopathy who received antithrombotic treatment and were followed up for a minimum of 6 months. The primary endpoint was the proportion of patients who achieved a pain visual analogue (VAS) score of zero and complete healing of livedoid vasculopathy ulcers at 3 months. The secondary endpoint was the proportion of patients who achieved a pain VAS score of zero and complete healing of livedoid vasculopathy ulcers at 6 months. Side-effects, improvements in the dermatological life quality index (DLQI), clinicodemographic features, and associated laboratory abnormalities were also analysed. Results Of the 26 patients who satisfied the inclusion and exclusion criteria, 20 were males. At 3 months, 65.3% (17) of patients achieved the primary endpoint. Of these, 11 had received rivaroxaban (10mg) once daily and six had received aspirin (150mg) once daily. At 6 months, 96.1% (25) of patients had complete ulcer healing and achieved a VAS pain score of 0. Of these, 11 patients had received rivaroxaban, eight had received a combination of rivaroxaban and aspirin, and six had received aspirin. The improvements in VAS and DLQI at 3 months and 6 months were significant. None of the patients had any adverse effects from the therapy. Limitations The small sample size and its retrospective nature were limitations of the study. Conclusion Monotherapy with rivaroxaban or aspirin can effectively heal the ulcers, successfully achieve pain control, and improve the quality of life in livedoid vasculopathy. However, a fraction of patients may need a combination of the two to achieve these therapeutic goals. Both monotherapy and combination therapy are safe and not associated with significant side effects.