Treatment of livedoid vasculopathy with sulodexide: A prospective study of 35 cases

BACKGROUND AND OBJECTIVES: Livedoid vasculopathy (LV) is a vascular occlusive disease, lacking a standardized treatment strategy. Sulodexide as a heparin-like agent has demonstrated favorable efficacy and safety profiles in certain thrombotic disorders. This study is designed to evaluate the efficacy and safety of sulodexide in the treatment of LV. PATIENTS AND METHODS: In this single-center prospective study, 35 patients diagnosed with LV were treated with sulodexide. Efficacy outcomes were assessed at standardized intervals: baseline and at weeks 1, 4, 8, 12 following treatment initiation. RESULTS: A total of 35 patients receiving sulodexide therapy were enrolled in the study. Thirty-one patients (88.6%) achieved complete clinical resolution with sulodexide monotherapy. Two patients (5.7%) withdrew due to suboptimal therapeutic response, while two others (5.7%) required adjunctive baricitinib. Eight (22.9%) mild adverse events related to sulodexide were reported. No moderate-severe adverse events occurred. CONCLUSIONS: 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.