Chondroitin sulfate safety in osteoarthritis patients and high cardiovascular risk

Chondroitin sulfate safety in osteoarthritis patients and high cardiovascular risk

O.А. Shavlovskaya

Olga A. Shavlovskaya, e-mail: shavlovskaya@1msmu.ru

International University of Restorative Medicine, Moscow

This article is aimed at assisting physicians in assessing the safety of chondroitin sulfate (CS)-based medicinal products in patients with osteoarthritis and high cardiovascular risk (CVR). The article also reviews the key characteristics of CS, including molecular standardization, molecular weight (MW), sources of raw materials, and their potential effects on hemostasis.

The greatest potential risk is associated with low-molecular-weight non-standardized CS (<1 kDa) and CS preparations with very high molecular weight, such as shark-derived CS (20.5–26.0 kDa) or fish-derived CS (27.0–34.0 kDa), since their biological effects may be uncontrolled, particularly when used concomitantly with indirect anticoagulants.

Analysis of the available study data suggests that standardized CS, specifically Chondroguard®, is safe for use in patients with high CVR and has no clinically significant effect on blood hemostasis. CS may potentiate the effects of indirect anticoagulants; however, it is not an analogue of these agents and does not directly affect blood coagulation factors. CS may be used in combination with indirect anticoagulants and antiplatelet agents, provided that more frequent laboratory monitoring of the patient’s underlying condition is performed. Thus, only standardized CS preparations, such as Chondroguard®, can be considered safe for patients with high cardiovascular risk and may be widely used in outpatient clinical practice.

Keywords: osteoarthritis, chondroitin sulfate, cardiovascular risks, anticoagulants, antiplatelet agents, Chondroguard.

For citation: Shavlovskaya O.А. Chondroitin sulfate safety in osteoarthritis patients and high cardiovascular risk. RMJ. 2026;5:32–38. DOI: 10.32364/2225-2282-2026-5-6