Unfractionated Heparin for Hemodialysis: Still the Best Option

Cronin, Robert E.; Reilly, Robert F.

doi:10.1111/j.1525-139x.2010.00770.x

Cited by 79 publications

(96 citation statements)

References 47 publications

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“…However, other important uses are in acute coronary syndromes (Howard et al, 2014), extracorporeal circuitry (Lim et al, 2004;Sonawane et al, 2006;Cronin and Reilly, 2010;Davenport, 2011;Pon et al, 2014), and maintenance of the patency of indwelling catheters Kordzadeh et al, 2014). It should be noted that LMWH preparations differ in their characteristics (Hovanessian 1999;Hirsh et al, 2001;Gray et al, 2008;Garcia et al, 2012;Guerrini and Bisio, 2012); hence, their clinical effects cannot be expected to be identical or interchangeable.…”

Section: Clinical Use As An Anticoagulant/ Antithromboticmentioning

confidence: 99%

Pharmacology of Heparin and Related Drugs

et al. 2015

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Section: Clinical Use As An Anticoagulant/ Antithromboticmentioning

confidence: 99%

Pharmacology of Heparin and Related Drugs

et al. 2015

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“…Without systemic anticoagulation, these extracorporeal and indwelling devices can rapidly occlude due to thrombosis because clots form when fibrin and platelets in the flowing blood adhere to the surfaces of these artificial materials 5 . Unfortunately, heparin causes significant morbidity and mortality including post-operative bleeding, thrombocytopenia, hypertriglyceridemia, hyperkalemia and hypersensitivity 6 , and its use is contraindicated in several patient populations 7 . In fact, the majority of drug-related deaths from adverse clinical events in the United…”

Section: ____________________________________________________________mentioning

confidence: 99%

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

et al. 2014

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________________________________________________________________Countless lives have been saved by implantable medical devices (e.g., total artificial hearts, ventricular assist devices, pacemakers, cardioverterdefibrillators, and central lines) and extracorporeal devices that flow whole human blood outside the body through indwelling catheters and external circuits, during cardiopulmonary bypass (CPB), hemodialysis, and extracorporeal membrane oxygenation (ECMO) 1,2 . However, the need to co-administer soluble anticoagulant drugs, such as heparin, with many of these procedures, significantly reduces their safety and hampers their effectiveness 3,4 . Without systemic anticoagulation, these extracorporeal and indwelling devices can rapidly occlude due to thrombosis because clots form when fibrin and platelets in the flowing blood adhere to the surfaces of these artificial materials 5 . Unfortunately, heparin causes significant morbidity and mortality including post-operative bleeding, thrombocytopenia, hypertriglyceridemia, hyperkalemia and hypersensitivity 6 , and its use is contraindicated in several patient populations 7 . In fact, the majority of drug-related deaths from adverse clinical events in the UnitedStates are due to systemic anticoagulation 8 .This need to prevent blood clotting while minimizing administration of anticoagulant drugs has led to the search for biomaterial surface coatings that can directly suppress blood clot formation. The most successful approach to date has been to chemically immobilize heparin on blood-contacting surfaces to reduce thrombosis and lower anticoagulant administration 9,10 . Although this approach has been widely adopted, major limitations persist because the surface-bound heparin leaches, resulting in a progressive loss of anticoagulation 24,25 . Importantly, the TP continues to retain the free LP as a thin mobile liquid layer even when the surface is challenged with a flowing immiscible fluid, such as blood (Fig. 1a). We refer to this unique anti-thrombogenic bilayer composed of the TP and LP coating as a Tethered-Liquid Perfluorocarbon (TLP) surface. RESULTS A generic blood repellent surface coatingTo test the anti-adhesive properties of the TLP coating method, we examined surface adhesion of fresh whole human blood on an acrylic surface sloped at an angle of 30 degrees, with or without a TLP coating composed of tethered perfluorohexane and liquid perfluorodecalin. Blood droplets immediately adhered to the control uncoated acrylic surface and left a trail of blood components over the course of 5 sec (Fig. 1b, top, Supplementary Fig. 1 and Supplementary Movie 1).In contrast, when the same surface was coated with TLP, the blood droplet almost immediately slid off the surface (< 0.3 sec), and remarkably, there was no evidence of any residual blood trail (Fig. 1b, Supplementary Fig. 1 and Supplementary Movie 2). We quantified blood adhesion to surfaces by measuring the minimum angle required to cause a droplet to slide ("sliding angle") ( Fig. 1c). Control uncoated s...

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“…[50][51][52][53] IL layers have been shown in several systems to prevent adhesion of proteins and blood both in vitro and in vivo, which is a promising step toward decreasing the need for systemic anticoagulants. Fluorocarbon-infused wrinkled surfaces showed a 96% reduction in bovine fibrinogen deposition, a significant reduction (P < .001) in platelet adhesion and reduction in whole blood clotting time by up to 95% (correlated to antithrombogenicity) compared to controls.…”

Section: Anti-thrombogenic Surfacesmentioning

confidence: 99%

Immobilized liquid layers: A new approach to anti-adhesion surfaces for medical applications

Sotiri

Overton

Waterhouse³

et al. 2016

Exp Biol Med (Maywood)

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Surface fouling and undesired adhesion are nearly ubiquitous problems in the medical field, complicating everything from surgeries to routine daily care of patients. Recently, the concept of immobilized liquid (IL) interfaces has been gaining attention as a highly versatile new approach to antifouling, with a wide variety of promising applications in medicine. Here, we review the general concepts behind IL layers and discuss the fabrication strategies on medically relevant materials developed so far. We also summarize the most important findings to date on applications of potential interest to the medical community, including the use of these surfaces as anti-thrombogenic and anti-bacterial materials, anti-adhesive textiles, high-performance coatings for optics, and as unique platforms for diagnostics. Although the full potential and pitfalls of IL layers in medicine are just beginning to be explored, we believe that this approach to anti-adhesive surfaces will prove broadly useful for medical applications in the future.

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Unfractionated Heparin for Hemodialysis: Still the Best Option

Cited by 79 publications

References 47 publications

Pharmacology of Heparin and Related Drugs

Pharmacology of Heparin and Related Drugs

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

Immobilized liquid layers: A new approach to anti-adhesion surfaces for medical applications

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