Pharmacological Treatment of Patients with Chronic Critical Limb Ischemia: L-Propionyl-Carnitine Enhances the Short-Term Effects of PGE-1

Purpose. To evaluate the therapeutic effects of L-propionyl-carnitine (LPC) in patients with critical limb ischemia (CLI), as defined by the TASC guidelines. Methods. The study, double-blinded, randomised, assessed intravenous infusion of LPC 1.2 g/day in combination with PGE-1, 60 mg/day (LPC group: 37 patients), or PGE-1 only (control group: 38 patients) in a total of 75 patients suffering from CLI. Treatment duration was 20 days. We evaluated rest pain, maximum walking distance (MWD) and skin ulcer size. Results. In both groups we observed a significant reduction in pain score and ulcer size and an increase in MWD. In the patients treated with the combination, the improvement was greater: median value for pain score decreased from 2.75 to 0.85 in the LPC group and from 2.51 to 1.71 in the control group; MWD increased from 55M to 130M in the LPC group, and from 55M to 102M in the control group; median decrease of ulcer size was significantly greater in patients treated with LPC + PGE1. Conclusions. Our study shows that LPC, whose effectiveness on claudication is already known, has favourable effects in patients with CLI, since it reinforces the effects produced by PGE-1.