Investigation in the use of topical solutions for management or prevention of thrombosis in traumatized vessels.
Systemic or local infusion of anticoagulants, platelet antiaggregating agents, and/or fibrinolytic agents for preventing thrombosis carries an inherent risk of generalized or localized hemorrhage. When the thrombotic stimulus is confined to a small region of traumatized vasculature, a new avenue of therapeutic approach [correction of aproach] is suggested which is achieved by topical irrigation of a compound specifically designed to bind to the lumenal surface and prevent surface-mediated thrombosis. Several agents have been developed and tested in animal models of simulated vascular trauma. Small peptides homologous to regions of the fibrinogen molecule that bind to platelet receptors and/or participate in fibrin strand cross-linkage can inhibit the incidence of thrombotic occlusion. Exogenous tissue factor pathway inhibitor can also prevent trauma-induced thrombosis. When vessels are surgically exposed during vascular reconstruction, the antithrombotic agent can be irrigated across the injured surface without the need for systemic infusion. This creates a thrombus-resistant surface in the regions of injured vasculature that receive direct application of the topical agent. This new approach to antithrombotic therapy may reduce the risk of spontaneous bleeding in trauma patients undergoing vessel repair and reconstruction. These new agents hold promise for site-specific targeting of antithrombotic therapy.
Cooley
B C
BC
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, USA.
Gould
J S
JS
D000287:Administration, Topical; D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008866:Microsurgery; D009131:Muscle, Smooth, Vascular / Q000293:injuries* / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D007507:Therapeutic Irrigation; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors