COMMENTARY

SURVET: Evaluating Sulodexide for Deep Vein Thrombosis

Samuel Z. Goldhaber, MD

Disclosures

March 29, 2016

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Samuel Z. Goldhaber, MD: Hello. This is Dr Sam Goldhaber for the Clot Blog at theheart.org on Medscape, speaking to you from the American Heart Association (AHA) Scientific Sessions in Orlando, Florida.

Today I'm going to speak about a recently published trial[1] in Circulation that introduces us to a new drug that can be used for long-term extended treatment of patients who've had a previous deep vein thrombosis (DVT) or pulmonary embolism (PE). It's called sulodexide, and it was studied in a randomized controlled trial, called the SURVET study.

And sulodexide is a glycosaminoglycan. It's not quite an anticoagulant. It has a lot of antithrombotic properties and a lot of profibrinolytic properties. And it has, in small studies[2,3,4], a remarkable safety record with negligible bleeding complications.

The issue that was tested in the SURVET study is whether after about 6 months of anticoagulation for patients with an unprovoked DVT or pulmonary embolism, if they were then switched from the anticoagulant to sulodexide and followed for the next 2 years, would they have a lower rate of recurrent venous thromboembolism compared with patients randomized to a placebo?

And what was shown in the study of 615 patients with idiopathic DVT or pulmonary embolism after their initial standard course of anticoagulation followed by randomization either to sulodexide or to a placebo for sulodexide, is that with 2 additional years of sulodexide or placebo, there was a 50% reduction in recurrent venous thromboembolism in the sulodexide group compared with the placebo group. On top of this, there were zero major bleeding complications in the sulodexide group.

This seems to be potentially a dream-come-true type of strategy that deserves our attention. Particularly because we know that with unprovoked and idiopathic DVT and pulmonary embolism, the 10-year rate of recurrent events without any anticoagulation after an initial course of anticoagulation is in the order of 30% to 50%. And to have a recurrence rate of 30% to 50% is totally unacceptable.

Sulodexide appears to offer a very safe strategy and one that's quite effective, too, in markedly reducing the rate of recurrent venous thromboembolism after standard anticoagulation is discontinued.

So stay tuned for further studies and possibly an application for FDA approval for sulodexide, which would really add to our therapeutic armamentarium.

Another approach, of course, would be just to continue anticoagulation indefinitely in high-risk patients with idiopathic acute venous thromboembolism. But sulodexide might be quite suitable for those patients who are at a little bit of lower risk of recurrence, where it's felt to be safe to discontinue the anticoagulant, and then they could be switched to a sulodexide regimen.

This is Dr Sam Goldhaber signing off for the Clot Blog.

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