Influence of Antiplatelet Drugs on Platelet-Surface Interactions
Platelet aggregates are important in the thromboembolic complications of prosthetic devices, and drugs that alter platelet function have shown promise in clinical trials. Results with these drugs have increased insight into the interaction of platelets with artificial materials, particularly when the clinical experience has been correlated with the results of in vitro models.
In a bead column/surface contact model, the characteristic interactions of platelets with artificial surfaces resemble effects of adding thrombin or ADP to platelet-rich plasma. Anti-inflammatory agents and other antiplatelet drugs inhibit these reactions. Results in an in vivo model, survival of 51Cr-labeled platelets in sheep bearing arteriovenous shunts of test materials, correlate well with results in the in vitro model. Findings in these model systems indicate that the initial events upon contact of a surface with plasma proteins persistently influence the long-term behavior of that surface toward blood.
A review of clinical studies discusses the effect of antiplatelet drugs on platelet survival and also on thrombotic complications of heart valve replacement and other conditions employing prosthetic devices.
KeywordsThromboembolic Complication Antiplatelet Drug Prosthetic Heart Valve Arteriovenous Shunt Prosthetic Device
Unable to display preview. Download preview PDF.
- 1.Berger S, Salzman EW: Thromboembolic complications of prosthetic devices. In PROGRESS IN HEMOSTASIS AND THROMBOSIS, Vol. II, edited by Spaet TH. New York, Grune and Stratton, Inc., 1974, p. 273.Google Scholar
- 2.Salzman EW: Blood platelets: Their behavior with respect to extracorporeal membrane oxygenation. In ARTIFICIAL LUNGS FOR ACUTE RESPIRATORY FAILURE, edited by Zapol WM, Qvist J. Washington D.C., Hemisphere Corp., 1976, p. 105.Google Scholar
- 4.Mason RG: The interaction of blood hemostatic elements with artificial surfaces. In PROGRESS IN HEMOSTASIS AND THROMBOSIS, Vol. 1, edited by Spaet TH. New York, Grune and Stratton, 1972, p. 141.Google Scholar
- 5.Scarborough DE: The pathogenesis of thrombosis in artificial organs and vessels. CURR TOP PATHOL 54: 95, 1971.Google Scholar
- 6.Leonard EF, Friedman LI: Thrombogenesis on artificial surfaces: A flow reactor problem. CHEM ENG PROGR SYMP SER 66: 59–71, 1970.Google Scholar
- 7.Bruck SD (Ed): BLOOD COMPATIBLE SYNTHETIC POLYMERS: AN INTRODUCTION. Springfield, Mo., Charles C Thomas Publishers, 1974.Google Scholar
- 9.Genton E, Gent M, Hirsh J, Harker LA: Platelet-inhibiting drugs in the prevention of clinical thrombotic disease. N ENGL J MED 293:1174–1178, 1236–1240, 1296–1300, 1975.Google Scholar
- 17.Wilner GD, Casarella WJ, Fenoglio C, Baier RE: In vivo fibrinopeptide a generation induced by angiographic catheters. THROMB HAEMOSTAS 38: 73, 1977.Google Scholar
- 21.Coe N, Collins R, Jagoda A, Brier D, Lindon J, Merrill E, Cohen R, Salzman E: In vivo assessment of thromboresistant materials by determination of platelet survival. THROMB HAEMOSTAS 38: 204, 1977.Google Scholar
- 29.Salzman EW: Thromboembolic complications of cardiac and vascular prostheses. In SURGERY OF THE CHEST, edited by Sabiston DC, Spencer FG. Philadelphia, W.B. Saunders Co., 1974, p. 1220.Google Scholar
- 36.Taguchi K, Matsumura H, Washizu T, Hírao M, Kato K, Kato E, Mochizuki T, Takamura K, Mashimo I, Morifuji K, Nakagaki M, Suma T: Effect of athrombogenic therapy, especially high dose therapy dipyridamole, after prosthetic valve replacement. J CARDIOVASC SURG 16: 8–15, 1975.Google Scholar
- 37.Björk V, Henz A: Management of thrombo-embolism after aortic valve replacement with the Bjork-Shiley tilting disc valve. Medicamental prevention with dicumarol in comparison with dipyridamole–acetylsalicyclic acid. Surgical treatment of prosthetic thrombosis. SCAND J THORAC CARDIOVASC SURG 9: 183–191, 1975.PubMedCrossRefGoogle Scholar
- 38.Weily HS, Genton E: Altered platelet function in patients with prosthetic mitral valves. Effects of sulfinpyrazone therapy. CIRCULATION 42 (Suppl 3): 205, 1970.Google Scholar
- 41.Arrants JE, Hariston P, Lee WH, Jr.: Use of dipyridamole (persantine) in preventing thromboembolism following valve replacement. CHEST 58: 275, 1970.Google Scholar
- 43.Rabello C, Rivas JA, Rocha F et aZ.: Estudo da açâo de Dipiridamol na evoluçâo de pacientes submetiedos â substitui çao de prbteses valvares. REV BRAS CLIN TER 2: 95, 1973.Google Scholar
- 44.Moriau M, Ferrant A, Beys C, Hurlet A, Chalant C, Ponlot R, Jaumain P, Goenen M, Masure R: Evaluation of the antithrombotic properties of suloctidil in patients with substitute heart valves. THROMB HAEMOSTAS 38: 96, 1977.Google Scholar
- 50.Jacobsson B: Use of dextran for prophylaxis against thromboembolic complication in arterial catheterization. ACTA CHIR SCAND (Suppl) 387: 103, 1968.Google Scholar
- 52.Slichter SJ, Harker L, Sauvage L: Platelet consumption as a measure of endothelialization of aorta-femoral grafts. PROC AM SOC HEMATOL, Florida, 1972, p. 46.Google Scholar
- 53.Blakely JA, Pogoriler G: A prospective trial of sulfinpyrazone after peripheral vascular surgery. THRONE HAEMOSTAS 38: 238, 1977.Google Scholar
- 60.Backmann F, McKenna R, Cole ER, Najafi H: The hemostatic mechanism after open-heart surgery. I. Studies on plasma coagulation factors and fibrinolysis in 512 patients after extracorporeal circulation. J THORAC CARDIOVASC SURG 70: 76–85, 1975.Google Scholar
- 61.Bick RL: Alterations of hemostasis associated with cardiopulmonary bypass: Pathophysiology, prevention, diagnosis, and management. SEMIN THROMB HEMOSTAS 3: 59–82, 1976.Google Scholar
- 62.Harbury CB, Galvan CA: A bleeding diathesis associated with a platelet storage pool deficiency acquired during cardiopulmonary bypass surgery. THROMB HAEMOSTAS 38: 237, 1977.Google Scholar
- 70.Bloom S, Zapol W, Wonders T, Berger S, Salzman E: Platelet destruction during 24 hour membrane lung perfusion. TRANS AM SOC ARTIF INTERN ORGANS 20: 299–305, 1974.Google Scholar
- 71.Winchester JF, Forbes CD, Courtney JM, Prentice CRM: Effect of sulfinpyrazone and aspirin on platelet loss induced in vitro by activated charcoal hemoperfusion. THROMB HAEMOSTAS 38: 93, 1977.Google Scholar