New EVF Guidelines publication entitled Management of CVD of lower limbs – Part II (A. Nicolaides et al. Int. Ang. 2020) reports Sulodexide scientific evidences in the dedicated chapter to Prevention of Post-Thrombotic Syndrome, defining the scheme for best therapeutic use of the drug.
PTS is still today the most frequent complication of DVT which affects 30-50% of patients within 5-10 yrs since VTE index event, notwithstanding anticoagulant therapy. Prevention of recurrent DVT is considered the main strategy to reduce PTS incidence and extended prophylaxis with effective drugs with very low bleeding risk, as in the case of Sulodexide, reveals Grade A evidence for DVT prevention and Grade B evidence for PTS prevention.
Based on medications knowledge, EVF guidelines define the scheme of appropriate drug selection taking in account the individual risks of recurrence and bleeding, according to which Sulodexide is the appropriate choice for extended prophylaxis: in (a) patients at high risk of recurrence with high risk of bleeding; (b) patients at intermediate risk of recurrence with high risk of bleeding; (c) patients at low risk of recurrence. Moreover, because of compression therapy evidences are robust for PTS treatment of oedema, but not for PTS prevention, double pillars PTS prevention combining elastic compression with Sulodexide seems an interesting option to better PTS prevention results.