Associations between coagulation factors and livedoid vasculopathy and the efficacy and safety of rivaroxaban in patients with livedoid vasculopathy: a retrospective study

The mechanism of livedoid vasculopathy (LV) remains unknown.To investigate the association between coagulation factors and LV and to assess the efficacy and safety of rivaroxaban in the treatment of patients with LV.From May 2019 to July 2022, 89 LV patients and 35 healthy controls were included in the cross-sectional cohort to measure the levels of coagulation factors. In addition, 55 LV patients treated with rivaroxaban were included in the treatment cohort to assess the complete remission rate of ulcers (n=44) and retiform purpura (n=11) within 12 weeks.In the cross-sectional cohort, the activities of coagulation factor X in LV patients were significantly higher than healthy controls (median [IQR]: 110.5% [97.5-127.0%] vs 101.3% [91.6-115.6%]; P=0.047). In addition, the coagulation factor X activities in the progressive stage were higher than in the stable stage (median [IQR]: 111.6% [102.3-132.5%] vs 105.4% [92.9-118.8%]; P=0.037). Moreover, the coagulation factor X activities were higher in the progressive stage than in the stable stage in the paired LV patients (P=0.035). In the treatment cohort of rivaroxaban, 90.9% (40/44) of patients with ulcers achieved complete remission within 12 weeks, and 72.7% (8/11) of patients with retiform purpura achieved complete remission within 12 weeks. Mild side effects occurred in 25.5% of patients, including menorrhagia (n=10), gingival bleeding (n=3), and hemorrhage (n=1).It was demonstrated that coagulation factor X was associated with the incidence and severity of LV. In addition, rivaroxaban was an effective and safe treatment for ulcers and retiform purpura of LV.