Thrombogenicity of small-diameter prosthetic grafts: relative contributions of graft-associated thrombin and factor Xa.
OBJECTIVE
We evaluated the contributions of coagulation factors IIa (thrombin) and Xa to small-diameter prosthetic graft thrombogenicity in vivo.


METHODS
Preclotted and nonpreclotted (collagen-coated) polyester grafts were studied before and 24 hours after implantation into pig femoral arteries. After incubation of explanted grafts was performed with plasma depleted of vitamin K-dependent coagulation factors by barium chloride adsorption (Ba-plasma), graft-associated thrombin activity was determined by radioimmunoassay for fibrinopeptide A. Fibrinopeptide A levels reflect thrombin-mediated fibrin formation. Factor Xa activity was characterized by measuring activation of prothrombin added to Ba-plasma.


RESULTS
Thrombin and factor Xa were associated with the luminal surfaces of preclotted grafts before and 24 hours after implantation. Nonpreclotted grafts had negligible procoagulant activity before implantation. After 24 hours in vivo graft-associated factor Xa activity was similar in both nonpreclotted and preclotted grafts; however, more thrombin was bound to nonpreclotted coated grafts (p < 0.01).


CONCLUSIONS
The procoagulant activity of small-diameter prosthetic grafts persists for 24 hours after implantation and is attributable not only to graft-associated thrombin but also to de novo thrombin elaboration induced by factor Xa. Moreover, graft-associated procoagulant activity is not dependent on preclotting because it develops on nonpreclotted, collagen-coated grafts as well. Treatment strategies to attenuate graft thrombosis may require the inhibition of both thrombin and factor Xa.
Toursarkissian
B
B
Department of Surgery, University School of Medicine, Washington.
Eisenberg
P R
PR
Abendschein
D R
DR
Rubin
B G
BG
D000327:Adsorption; D000818:Animals; D017609:Barium Compounds / Q000494:pharmacology; D001777:Blood Coagulation; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002712:Chlorides / Q000494:pharmacology; D003094:Collagen; D015951:Factor Xa / Q000378:metabolism*; D005263:Femoral Artery / Q000601:surgery; D005337:Fibrin / Q000096:biosynthesis; D005344:Fibrinopeptide A / Q000032:analysis / Q000378:metabolism; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000378:metabolism; D011091:Polyesters; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D011516:Prothrombin / Q000378:metabolism; D013499:Surface Properties; D013552:Swine; D013917:Thrombin / Q000378:metabolism*; D013927:Thrombosis / Q000209:etiology* / Q000378:metabolism; D014812:Vitamin K / Q000037:antagonists & inhibitors
D017609:Barium Compounds; D002712:Chlorides; D011091:Polyesters; D011093:Polyethylene Terephthalates; C024986:barium chloride; D014812:Vitamin K; D005344:Fibrinopeptide A; D011516:Prothrombin; D005337:Fibrin; D003094:Collagen; D013917:Thrombin; D015951:Factor Xa