I'm very curious to hear from the #IACI community on experience with Sulodexide vs Pentoxifyline vs sildenafil vs Nattokinase. I'm also wondering if any of you are combining these with capillaroscopy clinically to follow the impact on blood flow dynamics of the microvasculature?
Michael R Scoma MD
@DrMichaelScoma
10 Nov 2024
Replying to @julierehmeyer @loscharlos
Hi all - I have a patient in France who I manage remotely who I recommended sulodexide as an alternative to my preferred drug, pentoxifyline, which apparently is not available there. It works as an anti-thrombotic, anti-inflammatory, endothelial protective agent.

Feb 20, 2026 · 11:01 AM UTC

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Replying to @ImmunoFever
I am! I do serial capillaroscopy snd am getting sulodexide and dipyridamole (PDE inhibitor at higher doses)
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Do you see changes in your capillaries with use? Do you use your capillary findings to guide treatment? I'm thinking specifically about differences between dilated, branched, twisting capillaries vs seeing microhemorrhages or endothelial damage
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Replying to @ImmunoFever
I respond well to Nattokinase, it’s been practically life saving. I trialled sulodexide (low dose 60mg) for 3 months in addition to the NK and saw no detectable differences. Sadly I did not have any capillaroscopy data around this.
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Replying to @ImmunoFever
Have had positive results in patients by going after microcirc blood flow clinically. Sulodexide not available in US but can use Sub-Cut LMW heparin for RAGE path instead. Nattokinase, especially at higher levels (8-12k) was one of personal game changers and good results using it with patients. Haven’t used pentox much but mechanism makes functional sense. (Deforms rbc so can squeeze through vessels better and also some antiTNF and some antiFibrin prop)
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Replying to @ImmunoFever
Pentoxyfillene seems to help my leg pain. Nattokinase seems to help my shortness of breath. If I go off either one of them, the symptoms return.
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Replying to @ImmunoFever
Pentoxifylline is primarily used to treat intermittent claudication by making blood "slippery" and improving its flow through narrow vessels. It is sometimes combined with sildenafil.
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Replying to @ImmunoFever
@organichemusic did a big MECFS & LC survey on tx (now published) which included nattokinase. She also ran at least a small survey on sildenafil on here, not sure if that was in the paper — my recollection is it helped some, not others.
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Replying to @ImmunoFever
Pentoxyfilline - helped my OI but gave constipation. I tried Cilostazol next (not as active in gut) but my back muscles became tight and painful Tadalafil - didn't do anything other than erections Nattokinase - no effect Haven't observed benefits in other pts taking sulodexide
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Replying to @ImmunoFever
Why Sildenafil instead of Tadalafil? I see no advantage. Long story short none of them worked. As usual there seems to be a small % that benefits, some get worse and for most it does nothing.
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Replying to @ImmunoFever
Need more information here. For what pathology? Why are these drugs being pitted against each other?
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Replying to @ImmunoFever
From living in a chair to able to exercise w/o PEM with nattokinase/serrapeptase, 22k/440k units, brought up slowly. 6 months in, I ramped up exercise quickly and had flares (fever & nausea). I suspect cytokine release from breaking microclots. Aerobic: ocular stroke @ 2.5 yrs.
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