Anticoagulant and Antiplatelet Agents:  Their Clinical and Device Application(s) Together with Usages to Engineer Surfaces

Abstract

An essential aspect of the treatment of patients with cardiovascular disease is the use of anticoagulant and antiplatelet agents for the prevention of further ischaemic events and vascular death resulting from thrombosis. Aspirin and heparin have been the standard therapy for the management of such conditions to date. Recently, numerous more potent platelet inhibitors together with anticoagulant agents have been developed and tested in randomized clinical trials. This article reviews the current state of the art of antiplatelet and anticoagulant therapy in light of its potential clinical efficacy. It then focuses on the usages of these agents in order to improve the performance of clinical devices such as balloon catheters, coronary stents, and femoropopliteal bypass grafting and extra corporeal circuits for cardiopulmonary bypass. The article then goes on to look at the usage of these agents more specifically heparin, heparan, hirudin, and coumarin in the development of more biocompatible scaffolds for tissue engineering.

Reduction in thrombosis and bacterial adhesion with 7 day implantation of S-nitroso-N-acetylpenicillamine (SNAP)-doped Elast-eon E2As catheters in sheep

“…6 Over the last 50 years, much has been learned about surface-induced thrombosis and many different strategies to create hemocompatible materials have been reported. 1,[7][8][9] Some of the surface modifications to improve hemocompatibility include hydrophilic or hydrophobic surfaces, zwitterionic polymers, and immobilized heparin. However, in a clinical setting many devices still require the use of systemic or localized anticoagulation (e.g., heparin lock solutions) to avoid device failure due to thrombosis.…”

New Developments in Tissue Engineering of Microvascular Prostheses

“…Later failure may also be due to thrombosis after stenotic occlusion of the vessel consequent upon the development of endothelial hyperplasia. Several methods have been applied in the past to reduce thrombosis after surgery (e.g., anti-thrombotic drugs in their surface or surface ligands (Kidane AG et al 2004). Results were better, although clinically satisfactory criteria were not achieved.…”

In vitro intestinal permeability studies, pharmacokinetics and tissue distribution of 6-methylcoumarin after oral and intraperitoneal administration in Wistar rats

“…On the other hand, some simple and complex coumarins have shown different biological activities, such as antibacterial, effects on the cardiovascular system, effects on the central nervous system, antioxidant activities, cytotoxicity, and anti-inflammatory properties (Grazul, Budzisz, 2009;Kidane et al, 2004;Beillerot et al, 2008;Anand, Singh, Singh, 2012;Sashidhara et al, 2011;Kang et al, 2009;Li et al, 2011;Hoult, Paydt, Paya, 1996). Furthermore, 6-methylcoumarin (6MC, Figure 1), another simple coumarin, has shown important anti-inflammatory activity in in vivo and in vitro models (Cárdenas et al, 2014).…”