Melkumyants Arthur, Buryachkovskaya Lyudmila, Lomakin Nikita, Antonova Olga, Docenko Julia, Ermishkin Vladimir, Serebruany Victor
National Medical Research Center of Cardiology, Moscow 121552, Russia.
Institute of Physics and Technology, Moscow 141701, Russia.
J Clin Med. 2022 Apr 2;11(7):1995. doi: 10.3390/jcm11071995.
Background. Despite the fact that COVID-19 usually manifests with severe pneumonia, there is a growing body of evidence that life-threatening multiorgan damage is caused by vascular and hemostatic abnormalities. Since there is no established therapy, assessing antithrombotics is indeed important. Sulodexide, a compound derived from porcine intestinal mucosa is a mixture of fast-moving heparin fraction (80%) and dermatan sulfate (20%), is approved in Europe and currently in trials for COVID-19 indication. Methods. This single-center, prospective, observational study included 28 patients with mild COVID-19 hospitalized in the Central Clinical Hospital of the Presidential Administration of the Russian Federation. Patients in the control group (n = 14) were treated using routine therapy according to current guidelines, while patients in the experimental group (n = 14) had the routine treatment supplemented with daily intravenous injections of sulodexide in 600-unit doses. Scanning electron microscopy was utilized to examine the blood specimens derived from the cubital vein at admission and at 10 days after hospitalization, which was approximately the average duration of patients’ treatment in the hospital (11.6 ± 0.4 days). Results. Sulodexide significantly (by 40%) diminished the score of circulating endothelial cells, potentially indicating its antiviral endothelium-protective properties. It also prevented the extra activation of the platelets and the formation of erythrocytic sludges. Among patients in the control group, the share of activated platelets rose from 37 ± 5% to 45 ± 6% (p = 0.04) over the course of the study period, whereas among patients in the experimental group, the share of activated platelets remained practically unchanged (43 ± 6% vs. 38 ± 4%, p = 0.22). The score of erythrocytic sludges in the control group remained practically the same (4.8 ± 1.1 at admission vs. 3.9 ± 0.9 after 10 days, p = 0.67), whereas in the experimental group, it significantly decreased (from 5.7 ± 1.7 to 2.4 ± 0.9, p = 0.03). Conclusions. Sulodexide is able to defend endothelium, normalize blood, and, seemingly, prevent thrombosis. Therefore, it may be considered as a promising and effective agent for the treatment of patients with mild COVID-19. Broader randomized trials are needed to assess whether the observed findings will transform into sustained long-term clinical benefit.
背景。尽管新型冠状病毒肺炎（COVID-19）通常表现为重症肺炎，但越来越多的证据表明，危及生命的多器官损伤是由血管和止血异常引起的。由于尚无既定的治疗方法，评估抗血栓药物确实很重要。舒洛地特是一种从猪肠黏膜中提取的化合物，是快速移动的肝素部分（80%）和硫酸皮肤素（20%）的混合物，在欧洲已获批准，目前正在进行针对COVID-19适应症的试验。方法。这项单中心、前瞻性、观察性研究纳入了28例在俄罗斯联邦总统府中央临床医院住院的轻症COVID-19患者。对照组（n = 14）的患者按照现行指南接受常规治疗，而实验组（n = 14）的患者在常规治疗的基础上，每天静脉注射600单位剂量的舒洛地特。利用扫描电子显微镜检查入院时和住院10天后从肘静脉采集的血液标本，10天大约是患者在医院的平均治疗时长（11.6±0.4天）。结果。舒洛地特显著（降低了40%）降低了循环内皮细胞评分，这可能表明其具有抗病毒的内皮保护特性。它还防止了血小板的过度活化和红细胞淤滞的形成。在研究期间，对照组患者中活化血小板的比例从37±5%升至45±6%（p = 0.04），而实验组患者中活化血小板的比例基本保持不变（43±6%对38±4%，p = 0.22）。对照组中红细胞淤滞评分基本保持不变（入院时为4.8±1.1，10天后为3.9±0.9，p = 0.67），而在实验组中则显著降低（从5.7±1.7降至2.4±0.9，p = 0.03）。结论。舒洛地特能够保护内皮、使血液正常化，并且似乎可以预防血栓形成。因此，它可能被视为治疗轻症COVID-19患者的一种有前景且有效的药物。需要进行更广泛的随机试验来评估观察到的结果是否会转化为持续的长期临床益处。
