Angiology Care Unit, University Hospital, Padua, Italy.
Am J Cardiovasc Drugs. 2012 Apr 1;12(2):73-81. doi: 10.2165/11599360-000000000-00000.
Chronic venous disease encompasses a range of venous disorders, including those involving the lower limbs resulting from venous hypertension. The spectrum of chronic venous disease signs and symptoms shows variable severity, ranging from mild (aching, pain, and varicose veins) to severe (venous ulcers). The pathophysiology of chronic venous disease is characterized by venous hypertension, which triggers endothelial dysfunction and inflammation leading to microcirculatory and tissue damage, and eventually to varicose veins and venous ulcers. Sulodexide is an orally active mixture of glycosaminoglycan (GAG) polysaccharides with established antithrombotic and profibrinolytic activity. The agent is used in the treatment of a number of vascular disorders with increased risk of thrombosis, including intermittent claudication, peripheral arterial occlusive disease and post-myocardial infarction. Sulodexide differs from heparin because it is orally bioavailable and has a longer half-life and a smaller effect on systemic clotting and bleeding. An increasing body of preclinical evidence shows that sulodexide also exerts anti-inflammatory, endothelial-protective, and pleiotropic effects, supporting its potential efficacy in the treatment of chronic venous disease. Clinical studies of sulodexide have shown that the agent is associated with significant improvements in the clinical signs and symptoms of venous ulcers, and is therefore a recommended therapy in combination with local wound care and bandages for patients with persistent venous leg ulcers. Preliminary evidence supports the use of sulodexide in the prevention of recurrent deep venous thrombosis. Sulodexide was generally safe and well tolerated in clinical trials, without hemorrhagic complications. Sulodexide therefore appears to be a favorable option for the treatment of all stages of chronic venous disease and for the prevention of disease progression.
慢性静脉疾病包括一系列静脉疾病，包括下肢静脉高压引起的疾病。慢性静脉疾病的体征和症状谱表现出不同的严重程度，从轻到重依次为（隐痛、疼痛和静脉曲张）到严重（静脉溃疡）。慢性静脉疾病的病理生理学特征为静脉高压，其引发内皮功能障碍和炎症，导致微循环和组织损伤，最终导致静脉曲张和静脉溃疡。舒洛地特是一种具有已确立抗血栓和纤维蛋白溶解活性的糖胺聚糖（GAG）多糖的口服活性混合物。该药物用于治疗多种血栓形成风险增加的血管疾病，包括间歇性跛行、外周动脉闭塞性疾病和心肌梗死后。舒洛地特与肝素不同，因为它可口服生物利用，半衰期更长，对全身凝血和出血的影响较小。越来越多的临床前证据表明，舒洛地特还具有抗炎、内皮保护和多效性作用，支持其在治疗慢性静脉疾病方面的潜在疗效。舒洛地特的临床研究表明，该药物与静脉溃疡的临床体征和症状的显著改善相关，因此是持续性静脉溃疡患者联合局部伤口护理和绷带治疗的推荐疗法。初步证据支持舒洛地特用于预防复发性深静脉血栓形成。在临床试验中，舒洛地特总体上安全且耐受良好，无出血并发症。因此，舒洛地特似乎是治疗慢性静脉疾病所有阶段和预防疾病进展的有利选择。
