CHIEF OF STAFF GRUPO DE ATENCIÓN VASCULAR INTEGRAL SAN LUIS POTOSÍ, San Luis Potosi, Mexico
Objective: Recent data suggest DVT is part of a pro inflammatory vascular condition. During the venous thromboembolism, devastating damage is done to the venous endothelial layer. The glycocalyx is seriously damaged during this inflammatory process. Sulodexide is a potent endothelial anti-inflammatory agent and a promoter of the glycocalyx recovery. Sulodexide represents an antithrombotic agent with multiple sites of action on blood coagulation and related inflammatory vascular processes found on D.V.T. This drug certainly possesses anti-inflammatory actions acting directly on the endothelial lining. We state that the concomitant use of sulodexide and one of the new oral anticoagulants, rivaroxaban, during the acute phase of venous thromboembolism seems to significantly accelerate the natural process of recovery and recanalization of the deep vein thrombosis process.
Methods: We made a study comparing two groups, 106 patients were included on the study. All patients had femoral, popliteal or below the knee DVT, confirmed by compression ultrasound. 46 patients received conventional treatment with Rivaroxaban 15 mg BID for the first 30 days plus 20 mmHg thigh high compression, the other group, 66 patients received same treatment plus Sulodexide 250 LRU BID for the first 30 days. Control ultrasound performed at 10, 20 and 30 days to evaluate progress of the thrombus process. We also measured circumference of the affected leg on 3 points at 10, 20, and 30 days, and QOL was measured thru CIVIQ-20 questionnaire.
Results: Both groups matched age, sex, and site of DVT. The group that received Sulodexide significantly reduced leg circumference at 20 days average of 2.6 cm above the control group, venous ultrasound was similar on both groups and CIVIQ-20 questionnaire was significantly better on the Sulodexide group 91 points pretreatment and 42 points at 20 days versus 93 points pretreatment and 52 points at 20 days on the Rivaroxaban only group.
Conclusions: Sulodexide is an agent that has multiple antithrombotic, anti-inflammatory and anticoagulant actions, as well as reparative effects on venous endothelium and endothelial glycocalyx. This agent seems to significantly accelerate the thrombolytic process and decrease the systemic and local inflammatory reaction provoked during the acute period of DVT and it also has some influence on the appearance and severity of post thrombotic syndrome. It is a secure adjuvant to new oral anticoagulants accelerating the recovery process of the patients with this problem.