International Round Table Post-COVID syndrome (TUN END-CoV Study)

This MUST (Major Understanding by Selected Topics) round table reunited the international experts S. Gianesini (ITALY), chairmen of the session, and J. Fareed (USA) to discuss with S. Abdesselem and L. Abid (TUNISIA) about their recent findings in the field of the vascular implication of long-COVID syndrome obtained by their landmark clinical trial: the Tun End-COV study.

As presented by Salem Abdesselem, the TUN END-CoV study involved 800 post-COVID patients located in Tunisia and it was structured according to 3 phases addressing, respectively: 1) the involvement of endothelial impairment in long-COVID syndrome, 2) the effectiveness of Sulodexide treatment in easing the symptoms of these patients, and 3) the 12-months clinical outcome of long-COVID patients. Phases 1 and 2 led to the publication of two remarkable research publications, while phase 3 is still ongoing.

In the first part of the study, patients were evaluated for the presence of endothelial dysfunction and long-COVID symptoms such as shortness of breath, fatigue, cough, palpitation, chest pain, neurocognitive difficulties, etc. Three out of four patients reported at least one of the typical long-COVID symptoms and microcirculation impairment was found to be predictive of the onset of such symptoms (Charfeddine et al., 2021).

In phase 2, a 3-week treatment with Sulodexide was found to significantly improve the endothelial dysfunction and long-COVID symptoms such as fatigue and chest pain, as well as palpitations and neurocognitive difficulties with results close to significance (Charfeddine et al., 2022). The recovery observed in the group treated with Sulodexide was between 50-80% against 40-50% of the control group. This is the first and unique trial showing the beneficial effect of Sulodexide on signs and symptoms in the long-COVID syndrome.

The eminent speakers discuss that this finding might introduce a switch to the clinical approach to long-COVID patients. While awaiting further developments and the results of phase 3 of the TUN END-CoV study, Tunisian guidelines already introduced recommendation for the use of Sulodexide use in long-COVID patients.

In conclusion, the top experts focused on the importance of this study outcome in its translation toward a better understanding of the venous endothelial inflammation and related thrombotic processes: a key topic in chronic venous disease best thromboprophylaxis protocols, particularly in a time of many COVID asymptomatic positive patients.