This article examines the endothelial protective role of the vascular glycocalyx. Macromolecules protruding above the surface of endothelial cells, consisting of proteoglycans, glycoproteins and especially glycosaminoglycans, due to their negative charge prevent the contact of protein molecules, platelets, white blood cells and adhesion molecules with the endothelium. It is the destruction of the glycocalyx that leads to the development of vascular complications and underlies many diseases. The pathogenesis of pre-eclampsia is also directly related to thinning and destruction of the glycocalyx. The glycocalyx is a target for the prevention of vascular pathology. The complex medication glycosaminoglycan sulodexide is considered by many researchers as an effective agent for the protection or restoration of the glycocalyx. There are several studies showing the efficacy of sulodexide for the prevention of obstetric complications in high-risk pregnant women. This article presents a clinical case of an effective use of sulodexide in the preconception period and in the second and third trimesters of pregnancy in a patient with a history of recurrent severe early pre-eclampsia.