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Leave-one-out analysis of ICD improvement measured in m in the sulodexide group. The plot shows the results on computed random effect size (raw difference in means and 95% interval of confidence) calculated removing one study at a time. The analysis indicates that the influence and the weight of each individual study are very light.

Leave-one-out analysis of ICD improvement measured in m in the sulodexide group. The plot shows the results on computed random effect size (raw difference in means and 95% interval of confidence) calculated removing one study at a time. The analysis indicates that the influence and the weight of each individual study are very light.

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Peripheral arterial disease is associated with very high cardiovascular risk. The main symptom is intermittent claudication, which strongly affects the quality of life. Therefore, treatment goals in peripheral arterial disease consist of the reduction of cardiovascular events and the relief of symptoms. An increase in pain-free walking distance, ev...

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... performed a random effect on studies with placebo as a control with a JADAD score >3, a comparable dose and length of therapy: the ICD difference resulted of þ91.4 m (SEM ¼ 17.52, z ¼ 5.21, p < 0.001). Taking into account the heterogeneity of the results in some of the studies (i.e. higher rise of Delta-ICD in sulodexide treated patients in the Bonalumi 60 paper), we analysed intra-group ICD differences with the leave-one-out meta-analysis method (Figure 3). ...

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... Although Sulodexide does not have a direct action on blood circulation, cardiac ejection fraction, blood pressure, or peripheral resistance, in patients with chronic venous disease, Sulodexide improves various parameters of venous hemodynamics (39)(40)(41). Clinical improvement with the use of Sulodexide has been repeatedly demonstrated in occlusive atherosclerosis of the lower limbs in observational, prospective, double-blind, randomized, multicenter, placebo-controlled trials (42)(43)(44)(45)(46)(47)(48). Sulodexide-induced positive hemorrheological changes are likely due to improvement of venous and arterial circulation. ...
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Objectives: To review the current knowledge regarding the mechanisms of action and the clinical indications of Sulodexide, a glycosaminoglycan with established efcacy for the prevention of recurrent venous thromboembolism, with reduced bleeding risk. A critical review of the Methods: literature regarding Sulodexide in several data sources between 1975 and 2020. A total of 481 articles were found and analyzed but only 21 articles were considered for this review. Antithrombotic effects of Sulodexide include vas Results: cular endothelial protection, diminished platelet aggregation in response to several stimuli, inhibition of plasma coagulation factors Xa and thrombin, enhancement of brinolysis secondary to reducing PAI-1 and increasing of tPA, and decreased blood viscosity. Compared with other extended treatments, Sulodexide decreases mortality and bleeding episodes. Due to its broad range of pleiotropic effects and mainly a Conclusions: ntithrombotic, Sulodexide has emerged as a therapeutic option for the prevention of recurrent venous thromboembolism in subjects with high risk of bleeding, including elderly patients.
Article
Background: medical correction of the hemostatic system is one of the most important directions for complex treatment of obliterating diseases of lower limbs arteries (ODLLA), including cases of chronic limb-threatening ischaemia (CLTI).Aim: to evaluate the efficacy and safety of the sulodexide use in patients with ODLLA when conducting a comprehensive treatment of CLTI.Patients and Methods: 520 patients underwent two-center prospective study, 318 of whom (211 — with signs of ODLLA, 107 — without signs of CLTI) underwent revascularization interventions, whereas, 202 patients with CLTI received multicomponent complex conservative treatment. In addition to standard treatment, 30 patients who underwent surgery interventions and the group of 50 patients receiving conservative treatment received sulodexide orally in 2 capsules bis in day (1000 LE/day). The severity of the pain syndrome, the distance of pain-free walking, some laboratory indicators of hemostatic system, as well as the presence of adverse events and complications were evaluated before and after treatment. Results: in operated patients with both CLTI and without it, regardless of the sulodexide use, there was a significant decrease in the severity of pain syndrome and an increase in the distance of pain-free walking. Sulodexide use was accompanied by reduced fibrinogen, D-dimer, soluble fibrin monomer complexes (SFMC) and plasminogen activator inhibitor (PAI-1) in the subgroup of patients with CLTI, and indicators of fibrinogen and PAI-1 in the subgroup of patients without CLTI (p<0.05). In non-operated patients with CLTI, sulodexide use was accompanied by a decrease in pain syndrome and indicators of fibrinogen, D-dimer, SFMC, and PAI-1 (p<0.05). However, it was less significant after performed revascularization. There were no adverse events or complications associated with the sulodexide use.Conclusions: improvement of clinical and laboratory parameters was mainly determined by the efficacy of performed limb revascularization. In the complex treatment of patients with ODLLA, the sulodexide use was safe and effective, which was manifested by a decrease in the pain severity, an increase in the distance of pain-free walking and normalization of some coagulogram indicators.KEYWORDS: chronic limb-threatening ischaemia, critical limb ischemia, obliterating diseases of lower limb arteries, complex treatment, sulodexide.FOR CITATION: Katelnitsky I.I., Darvin V.V., Zorkin A.A. Comprehensive treatment of patients with chronic limb-threatening ischaemia: are we using all the possibilities of anticoagulant therapy? Russian Medical Inquiry. 2020;4(7):445–451. DOI: 10.32364/2587-6821-2020-4-7-445-451.