Sequential Therapy With Low‐Molecular‐Weight Heparin and Rivaroxaban in Livedoid Vasculopathy: A Retrospective Analysis of 19 Cases

Livedoid vasculopathy is a vascular obstructive disease commonly treated with anticoagulants, including low‐molecular‐weight heparin and rivaroxaban. However, the long‐term use of subcutaneous nadroparin calcium injection can be inconvenient, and rivaroxaban may not rapidly relieve severe pain in some patients. In this study, we examined 19 patients with livedoid vasculopathy who received sequential low‐molecular‐weight heparin and rivaroxaban treatments. All patients received subcutaneous nadroparin calcium injections at the early stage, which were subsequently switched to oral rivaroxaban. The results showed that clinical symptoms improved in all patients after 12 weeks of treatment. Clinical scores decreased from 6.0 (IQR 4–8) to 5.0 (IQR 4–7) ( p < 0.001) after 1 week of treatment and decreased to 0 (IQR 0–4) ( p < 0.001) after 12 weeks. The pain visual score decreased from 5.0 (IQR 2–8) to 3.0 (IQR 1–5) ( p < 0.001) after 1 week of treatment and decreased to 0 (IQR 0–2, mean 0.3 ± 0.6) ( p < 0.001) after 12 weeks. Mild adverse effects, including slightly elevated liver enzyme levels, menorrhagia, and gingival bleeding, were observed in a few patients during treatment. Our study demonstrates that sequential treatment with low‐molecular‐weight heparin in combination with rivaroxaban is an effective, well‐tolerated, and convenient method for treating livedoid vasculopathy.