On the influence of glycocalyx on NO biosynthesis: The role of sulodexide

The glycocalyx is a special ultra-fine structure of glycosaminoand proteoglycans, 0.2–5 μm thick, covering the endothelium. Maintenance of the mechanisms of synthesis and secretion of the signaling molecule NO, this regulator of vascular tone, mitochondrial respiration, neurotransmission and immunity, occurs through the reconstruction of the glycocalyx. Sulodexide is a combination of natural glycosaminoglycans – heparan sulfate and dermatan sulfate, which are part of the glycocalyx. The antithrombotic effect of sulodexide, realized through the suppression of platelet adhesion and aggregation, mild anticoagulant and profibrinolytic effects, is well known. In addition to the prevention of thrombus formation, the use of sulodexide is one of the important areas of endothelial dysfunction therapy through the restoration of glycocalyx and NO biosynthesis. Evidence shows that the use of sulodexide is promising for the treatment of both arterial and venous thrombotic disorders in patients with type 2 diabetes mellitus (T2DM), arterial hypertension (AH), coronavirus infection COVID-19, after surgery, with thrombophilia, etc. A meta-analysis of study data demonstrates a reduced risk of death from cardiovascular causes with the use of sulodexide. As part of the personalized prescription of sulodexide, the results of endothelial dysfunction diagnostics should be taken into account. If the patient has a risk of thrombotic events, anticoagulants and antiplatelet agents should be used in accordance with clinical guidelines. Sulodexide has antithrombotic properties and is characterized by a low level of bleeding; it should be used when it is impossible to use anticoagulants with a high risk of bleeding, as well as if the patient has hypertension, type 2 diabetes, chronic venous diseases, and diseases of the arteries of the lower extremities.