Sulodexide

Sulodexide

Abstract: Sulodexide is a glycosaminoglycan with antithrombotic properties. The future role of sulodexide is possibly as an agent to prevent recurrent venous thromboembolism in those at higher risk of bleeding with warfarin and novel oral anticoagulants (NOACS).

Sulodexide is a glycosaminoglycan with antithrombotic properties. It corresponds to a mixture of heparin and dermatan sulfate having profibrinolytic properties and anti-inflammatory activity demonstrated in vitro [1]. Sulodexide has anti oxidant and anti glucotoxic effects which make it potentially beneficial in the treatment of diabetic kidney disease [2].

Sulodexide has been shown to reduce mural thrombus formation and total mortality in myocardial infarction [3]. It has been reported to cause regression of a carotid plaque in a patient when used in conjunction with pravastatin and antiplatelet agents, in a dose of 500 lipidic units* for 20 days a month for 3 years [4]. *Sulodexide releases lipoprotein lipase and reduces circulating lipid level like heparin. But unlike heparin, it has a longer half life and can be administered orally [5].

The future role of sulodexide is possibly as an agent to prevent recurrent venous thromboembolism in those at higher risk of bleeding with warfarin and novel oral anticoagulants (NOACS). SURVET study showed that sulodexide given after discontinuation anticoagulation reduced the risk of recurrence of unprovoked venous thromboembolism without an increase in bleeding risk [6].

A meta analysis has also documented that sulodexide produces significant reduction in blood pressure, especially in hypertensive subjects, possibly related to its effect on endothelial function and sodium hemostasis [7]. But this effect needs further evaluation in larger prospective studies.

The drug is a potential therapeutic option for chronic venous insufficiency including venous ulceration and prevention of venous thromboembolism. It has a low rate of major bleeding complications [8].

References

1. Ciszewicz M, Polubinska A, Antoniewicz A, Suminska-Jasinska K, Breborowicz A. Sulodexide suppresses inflammation in human endothelial cells and prevents glucose cytotoxicity. Transl Res. 2009 Mar;153(3):118-23.
   
2. Yan W, Zhou B, Shen Y, Xu G. and Antithrombotic Therapies for Diabetic Kidney Disease. Iran J Kidney Dis. 2015 Nov;9(6):413-20.
3. Condorelli M, Chiariello M, Dagianti A, Penco M, Dalla Volta S, Pengo V, Schivazappa L, Mattioli G, Mattioli AV, Brusoni B, et al. IPO-V2: a prospective, multicenter, randomized, comparative clinical investigation of the effects of sulodexide in preventing cardiovascular accidents in the first year after acute myocardial infarction. J Am Coll Cardiol. 1994 Jan;23(1):27-34.
4. Stivali G, Cerroni F, Bianco P, Fiaschetti P, Cianci R. Images in cardiovascular medicine. Carotid plaque reduction after medical treatment. Circulation. 2005 Oct 25;112(17):e276-7.
5. Hoppensteadt DA, Fareed J. Pharmacological profile of sulodexide. Int Angiol. 2014 Jun;33(3):229-35.
   
6. Andreozzi GM, Bignamini AA, Davì G, Palareti G, Matuška J, Holý M, Pawlaczyk-Gabriel K, Džupina A, Sokurenko GY, Didenko YP, Andrei LD, Lessiani G, Visonà A; SURVET Study Investigators. Sulodexide for the Prevention of Recurrent Venous Thromboembolism: The SURVET Study: A Multicenter, Randomized, Double-Blind, Placebo Controlled Trial. Circulation. 2015; 132: 1891-1897.
7. Olde Engberink RH, Rorije NM, Lambers Heerspink HJ, De Zeeuw D, van den Born BH, Vogt L.  Br J Clin Pharmacol. Br J Clin Pharmacol. 2015 Dec;80(6):1245-53.
8. Carroll BJ, Piazza G, Goldhaber SZ. Sulodexide in venous disease.
   J Thromb Haemost. 2019 Jan;17(1):31-38.