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Livedoid Vasculopathy — SCE Dermatology MCQ

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HardWound HealingLivedoid VasculopathySCE Dermatology

A 30-year-old woman with SLE and anti-phospholipid syndrome has livedoid vasculopathy with painful ankle ulcers and atrophie blanche. Standard anticoagulation with Warfarin has been suboptimal. What newer anticoagulant option has shown promise?

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Correct answer: D — Rivaroxaban (direct oral anticoagulant)

Rivaroxaban and other direct oral anticoagulants (DOACs) have shown promise for livedoid vasculopathy as an alternative to Warfarin, particularly in patients who are difficult to maintain in therapeutic INR range. Some case series report improved ulcer healing and reduced recurrence. However, evidence remains limited and DOACs are not yet formally guideline-recommended for this indication. Other treatments for LV include low-dose aspirin, Pentoxifylline, tissue plasminogen activator (low-dose), IVIG, and hyperbaric oxygen. The choice of anticoagulant should be guided by the underlying thrombophilia — notably, DOACs may be less effective than Warfarin in triple-positive APS patients (TRAPS trial).

Reference: BAD 2017; BJD Livedoid Vasculopathy; TRAPS Trial