Sulonex (sulodexide) / Alfasigma - LARVOL DELTA

Treatments for Tinnitus: Current Evidence, Emerging Therapies, and the Role of Corticosteroids (AAO-HNSF 2026) - "Agents such as selurampanel, acamprosate, sulodexide, and select antidepressant combinations showed improvement in some patients...Additional interventions, including lidocaine, botulinum toxin, and gentamicin, yielded positive effects, though gentamicin was associated with hearing loss...Among corticosteroids, dexamethasone was largely ineffective, while methylprednisolone showed more consistent symptom improvement... Overall, no single therapy demonstrated consistent efficacy across populations. While select pharmacologic agents, neuromodulation, and methylprednisolone showed potential, treatment responses varied widely. These findings underscore the need for more rigorous, high-quality clinical trials to inform evidence-based management of tinnitus."

Infectious Disease • Otorhinolaryngology

Hemodynamic disruption triggers glomerular barrier injury via endothelial glycocalyx degradation in nephrotic syndrome. (PubMed, Biomed Microdevices) - "We combined an adriamycin (ADR)-induced NS rat model with vascular-on-a-chip (VOAC) and glomerulus-on-a-chip (GOAC) platforms. In vivo, coagulation, hemorheology, EG structure and components, inflammatory adhesion molecules, and urinary protein excretion were assessed, with prednisone acetate and sulodexide used as mechanistically distinct comparators...These complementary models support reduced flow-associated mechanical stimulation as a plausible contributor to EG dysfunction and glomerular barrier leakage in NS. These data did not confirm that ADR-induced injury was entirely mediated by hemodynamic alterations; rather, they uncovered an EG-centered mechanobiological pathway that may operate alongside direct toxic and inflammatory insults."

Journal • Glomerulonephritis • Nephrology • Renal Disease

Effect of sulodexide on the walking, erectile and cognitive functions based on the findings of the ANDANTE study (PubMed, Angiol Sosud Khir) - "The ANDANTE study showed efficacy of sulodexide in patients with PAD. Taking sulodexide at a daily dose of 500-1000 LSU resulted in a statistically significant increase in the painless walking distance by 72.4%, improvement of self-reported walking ability by 71.0%, self-assessment of maintaining an erection by 14.8%, and cognitive function by 12.2%. These results were consistent irrespective of both whether the patients were given 3 months."

Clinical • Journal • Alzheimer's Disease • Atherosclerosis • Cardiovascular • CNS Disorders • Dementia • Pain • Peripheral Arterial Disease

Drug failure in diabetic kidney disease: translational barriers, target validation and trial de-risking strategies. (PubMed, Biochem Pharmacol) - "We compare successful development paths for SGLT2 inhibitors, finerenone and semaglutide with constrained or unsuccessful programmes involving dual RAAS blockade, bardoxolone methyl, endothelin receptor antagonists, apoptosis signal-regulating kinase 1 (ASK1) inhibition, immunomodulation, sulodexide and pyridoxamine. Across these examples, recurring vulnerabilities emerge in human target validation, animal-to-human translation, renal exposure, target engagement, pharmacodynamic biomarker selection, patient enrichment, endpoint choice and safety-constrained dosing. We propose a de-risking framework that prioritizes human tissue evidence, renal cell-specific causal validation, pharmacokinetic and pharmacodynamic integration, mechanism-aligned biomarkers, adaptive trial design and biology-guided patient selection."

Journal • Review • Acute Kidney Injury • Cardiovascular • Congestive Heart Failure • Diabetic Nephropathy • Heart Failure • Hematological Disorders • Immunology • Nephrology • Renal Disease

Pharmacological interventions targeting cognition and related clinical outcomes in vascular dementia: a systematic review and meta-analysis of randomized controlled trials. (PubMed, Eur J Clin Pharmacol) - "Galantamine and memantine showed small short-term cognitive effects; EGb 761® suggested a fragile, very low-certainty signal; patient-important benefits remain uncertain."

Clinical • Clinical data • Journal • Retrospective data • Review • Alzheimer's Disease • CNS Disorders • Dementia

Indwelling inferior vena cava filter as a persistent thrombotic risk factor: recurrent venous thromboembolism after anticoagulation withdrawal. (PubMed, Blood Coagul Fibrinolysis) - "Three months after switching to extended thromboprophylaxis with sulodexide, and following a prolonged journey, he developed recurrent DVT and PE. Anticoagulation was restarted. This case highlights the potential prothrombotic role of indwelling IVC filters and the uncertainty regarding optimal anticoagulation strategies."

Journal • Cardiovascular • Hematological Disorders • Musculoskeletal Diseases • Orthopedics • Respiratory Diseases • Venous Thromboembolism

Pharmacological interventions to treat chronic venous disease: A network meta-analysis. (PubMed, Phlebology) - "Pentoxifylline (Relative risk [RR] = 1.69; 95% CI: 1.34 - 2.14), Micronized Purified Flavonoid Fraction (RR = 1.68; 95% CI: 1.23 - 2.29) and Sulodexide (RR = 1.61; 95% CI: 1.16 - 2.23) significantly increased ulcer healing. Calcium dobesilate (RR = 0.22; 95% CI: 0.08 - 0.63) and Centella asiatica (RR = 0.30; 95% CI: 0.11 - 0.81) significantly reduced heaviness. Red vine leaf extract (RR = 0.62; 95% CI: 0.44 - 0.87) was significantly associated with fewer adverse events.ConclusionsPharmacological interventions were efficacious for CVD treatment."

Journal • Retrospective data • Review • Cardiovascular • Pain • Venous Ulcer

Endothelial Glycocalyx Shedding Emerges as a Dual Marker for Treatment and Diagnosis in Anaphylaxis. (PubMed, J Investig Allergol Clin Immunol) - "eGCX shedding, particularly of ESM-1, acts as a key mediator in murine anaphylaxis. Prophylaxis with sulodexide protects against severe reactions and improves survival. Therapies based on glycosaminoglycans and proteoglycans may mitigate the severity of anaphylaxis, and monitoring of eGCX dynamics could aid diagnosis."

Journal • ESM1

Expert Consensus on the Clinical Application of Sulodexide in Vascular Diseases. (PubMed, Adv Ther) - "Through a structured review and integration of published basic and clinical research evidence from China and abroad, it summarizes clinical efficacy and safety data for sulodexide in chronic venous disease, venous thromboembolism, peripheral arterial disease, and microangiopathy, highlighting the importance of rational use of sulodexide in vascular disease management. Additionally, based on evidence-based medicine and existing medical guidelines, specific clinical application recommendations are proposed."

Journal • Review • Cardiovascular • Diabetic Nephropathy • Nephrology • Peripheral Arterial Disease • Renal Disease • Venous Thromboembolism

Effect of alprostadil combined with sulodexide on elderly chronic kidney disease patients and the independent risk factors affecting curative results. (PubMed, Am J Transl Res) - "Alprostadil combined with sulodexide significantly improves renal function and clinical efficacy in elderly patients with CKD, and baseline Scr and UACR serve as useful predictors of treatment response."

Journal • Chronic Kidney Disease • Diabetes • Metabolic Disorders • Nephrology • Renal Disease

Evaluation of Pharmacological Therapies on Healing and Secondary Dermatological Characteristics of Venous Leg Ulcers: A Systematic Review and Network Meta Analysis (CDA 2026) - "The therapies to be evaluated are vasoactive agents, sulodexide, pentoxifylline, acetylsalicylic acid, topical and oral corticosteroids, and growth factor drugs. Through this study, we intend to evaluate and compare the efficacy of pharmacological therapies from various drug classes for the treatment of VLUs using both standard and secondary outcome measures. These results will further inform best practices for the treatment of VLUs and will provide valuable insight into their effects on dermatological characteristics of VLUs that have previously been unexplored, with the ultimate goal of improving patient care. Takeaway Message: Venous leg ulcers are a serious chronic condition with numerous available pharmacologic therapies, yet their comparative effectiveness remains poorly understood; this study aims to systematically quantify treatment effects and evaluate previously underreported secondary outcomes."

Retrospective data • Review • Infectious Disease • Venous Ulcer

The effect of sulodexide on the quality of life of patients with intermittent claudication: results of a multicenter observational study of ANDANTE (PubMed, Angiol Sosud Khir) - "ANDANTE's study showed an improvement in subjective physical by 24.9% and mental by 13.6% aspects of quality of life on the background of sulodexide therapy in patients with ZANK."

HEOR • Journal • Observational data • Alzheimer's Disease • Atherosclerosis • Cardiovascular • CNS Disorders • Coronary Artery Disease • Dementia • Diabetes • Erectile Dysfunction • Heart Failure • Hypertension • Metabolic Disorders • Pain • Peripheral Arterial Disease • Vascular Neurology

Sulodexide and micronized purified flavonoid fraction in the pharmacotherapy of varicose vein disease: a focus on vein-specific inflammation (PubMed, Angiol Sosud Khir) - "Pharmacotherapy efficacy depends on the stage of VVDLE: MPFF is optimal at early stages, while sulodexide or its combination with MPFF is preferable for advanced disease. A personalized treatment approach enables maximal clinical and biochemical benefits with a comparable safety profile."

Biomarker • Journal • Cardiovascular • Inflammation • Varicose Veins • MMP2 • MMP9

Sulodexide attenuates sepsis-induced lung injury in neonatal rats via TNF-α pathway. (PubMed, Pediatr Res) - "Sulodexide, a drug that has been used clinically for nearly four decades primarily in the management of adult vascular disorders, demonstrates both safety and therapeutic efficacy in a neonatal rat model of sepsis. This study provides the first experimental evidence supporting the repurposing of sulodexide for neonatal sepsis-associated acute lung injury. Sulodexide significantly attenuates inflammatory lung injury by modulating TNF-α pathway. These findings highlight sulodexide as a promising and readily translatable anti-inflammatory therapy for neonatal sepsis."

Journal • Preclinical • Acute Lung Injury • Cardiovascular • Infectious Disease • Oncology • Respiratory Diseases • Septic Shock • IFNG • IL1B • MAPK8 • SOCS3 • TNFA

Sulodexide protects against sepsis-induced liver injury in neonatal rat by attenuating oxidative stress, apoptosis, and NF-κB/MAPK signaling. (PubMed, Mol Biol Rep) - "SDX prevents LPS-induced liver injury in newborns by maintaining redox homeostasis, suppressing inflammation and apoptosis, and inhibiting NF-κB/ERK/JNK signaling; this suggests that SDX is a potential therapeutic agent for treating liver injury associated with neonatal sepsis."

Journal • Preclinical • Hepatology • Infectious Disease • Inflammation • Liver Failure • Septic Shock • CASP3 • IFNG • IL1B • TNFA

Venoactive drugs in the management of chronic venous disease: A critical appraisal of the evidence and comparison with international guidelines. (PubMed, Vascul Pharmacol) - "The review evaluates the efficacy of various VADs, including micronized purified flavonoid fraction (MPFF), rutosides, calcium dobesilate, sulodexide, horse chestnut seed extract, and red vine leaf extract. Different medical guidelines for treating CVD from around the world recommend using VADs, though with some discrepancies on recommendation gradings. While MPFF is referred to in these guidelines as a leading option, further research is needed to better understand how different VADs can be used most effectively in treating CVD."

Journal • Review • Cardiovascular • Hypertension • Inflammation • Pain • Venous Ulcer

Acquired platelet dysfunction induced by infection in an older patient: Severe hemorrhage despite normal platelet count. (PubMed, SAGE Open Med Case Rep) - "Treatment included platelet transfusion support, targeted anti-infection therapy, and adjunctive agents (ulinastatin and sulodexide) to address inflammation and endothelial dysfunction. The patient's platelet function normalized with the resolution of infection. This case highlights infection as an underrecognized etiology of acquired platelet dysfunction, particularly in older patients, where normal platelet counts may obscure the diagnosis of major platelet functional impairment."

Journal • Hematological Disorders • Infectious Disease • Inflammation • Pneumonia • Respiratory Diseases

RESTORING THE ENDOTHELIAL GLYCOCALYX REVERSES NITRIC-OXIDE MECHANOTRANSDUCTION DEFECTS AND LIMITS PRESSURE-OVERLOAD REMODELING IN TAC (ACC 2026) - " C57BL/6J mice underwent TAC or sham surgery and were treated with either vehicle or a glycocalyx-restoring agent (sulodexide) for 8 weeks... Loss of the endothelial glycocalyx disrupts NO mechanotransduction and contributes to vascular stiffening and maladaptive cardiac remodeling under pressure overload. Pharmacological restoration of the glycocalyx rescues NO signaling, improves vascular compliance, and limits TAC-induced remodeling."

Cardiovascular • Fibrosis • Heart Failure • Immunology • NOS3

Empagliflozin-mediated protection of heparan sulfate-rich endothelial glycocalyx during vascular inflammation. (PubMed, Biochem Pharmacol) - "In contrast, inhibitors of endogenous sheddases released in response to TNF, such as sulodexide or SB-3CT, reduced eGC disruption in TNF-exposed aorta. Furthermore, Empa improved the nanomechanical properties of the endothelium by reducing cortical stiffness elevated during TNF-induced inflammation ex vivo and in db/db mice in vivo. These findings reveal a previously unrecognized effect of empagliflozin on the vasculature, demonstrating its ability to attenuate eGC degradation during inflammation and to improve endothelial nanomechanical properties under both inflammatory and diabetic conditions."

Journal • Diabetes • Inflammation • Metabolic Disorders

PET-microplastics trigger endothelial glycocalyx loss via ER stress and ROS unleashing IL-1β-driven SMC switching and early aortic structural impairment. (PubMed, J Nanobiotechnology) - "Crucially, restoration of the glycocalyx using sulodexide mitigated endothelial dysfunction and downstream smooth muscle cells phenotypic switching. These findings establish endothelial glycocalyx degradation via endoplasmic reticulum stress-reactive oxygen species as a novel mechanism for PET-MPs-induced vascular injury and highlight glycocalyx protection as a potential strategy against environmental microplastic hazards."

Journal • IL1B

The importance of glycocalyx in the development of pathology of the cardiovascular system (PubMed, Angiol Sosud Khir) - "The review article presents data on the structural organization of the endothelial glycocalyx and its function in health and endothelial dysfunction accompanying circulatory system pathology. Particular attention is paid to the possibilities and peculiarities of its visualization using various techniques, as well as modern trends in correcting disorders of its function and structure."

Journal • Review • Cardiovascular

Sulodexide for limb salvage in refractory diabetic foot ulcer with arteriosclerosis obliterans: a case report. (PubMed, Front Endocrinol (Lausanne)) - "This case report suggests that highly selected DFU patients unresponsive to standard therapies including successful revascularization, Sulodexide may be a plausible salvage or adjunctive therapeutic option. This observation is strictly hypothesis-generating and its potential role warrants investigation in future prospective clinical trials."

Journal • Atherosclerosis • Cardiovascular • Peripheral Arterial Disease

Sulodexide protected the heart against ischemia/reperfusion injury by reducing oxidative stress, inflammation, and apoptosis in the isolated rat heart. (PubMed, Perfusion) - "Levels of Bax were significantly lower in PreSDX (p < 0.001), PostSDX (p < 0.01) and PrePostSDX (p < 0.001) groups than the IR group. The Bcl-2-associated X protein (Bax)//Bcl-2 ratio was also significantly higher in IR group than all three SDX treated groups (p's < 0.001).ConclusionsIt was concluded that SDX has anti-apoptotic, anti-inflammatory and antioxidant effects in both pre-ischemia and pre- and post-ischemia treatment and might be added to cardioplegia solutions in clinical practice."

Journal • Preclinical • B Cell Lymphoma • Cardiovascular • Inflammation • Lymphoma • Myocardial Ischemia • Oncology • Reperfusion Injury • BAX • CASP3

Treatment of livedoid vasculopathy with sulodexide: A prospective study of 35 cases. (PubMed, J Dtsch Dermatol Ges) - "Our study demonstrates that sulodexide monotherapy is a clinically effective and well-tolerated therapeutic option for patients with LV. Adjunctive JAK inhibitor therapy, when clinically indicated, may yield superior therapeutic outcomes."

Journal • Thrombosis

Venous Thrombosis Prophylaxis after Endovenous and Open Surgery for Varicose Veins: A Systematic Review and Network Meta-Analysis. (PubMed, Vasc Endovascular Surg) - "Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration."

Journal • Retrospective data • Review • Cardiovascular • Hematological Disorders • Thrombosis • Varicose Veins • Venous Thromboembolism