在高风险的干预环境中,早期的支架血栓发生率是由支架设计和部署驱动的,并由聚合物-药物涂层保护
Kumaran Kolandaivelu1, Rajesh Swaminathan, William J Gibson
177 Massachusetts Ave, Cambridge, MA 02139, USA. kkolandaivelu@partners.org
Circulation
|March 23, 2011
概括
释放药物的涂层可以减少支架血栓形成,这与人们普遍认为的相反. 支架的设计和部署显著影响凝血风险,细的支架和适当的放置将血栓形成的风险降到最低.
科学领域:
- 生物医学工程 生物医学工程
- 心血管研究研究心血管研究
- 材料科学 材料科学 材料科学
背景情况:
- 支架血栓是内血管程序的一个关键并发症.
- 药物释放涂层和支架设计在血栓形成中的作用仍在争论中.
- 现有的临床和动物数据关于支架血栓发生率是不确定的.
研究的目的:
- 调查药物泄露涂层是否固有地增加了血栓生成性.
- 确定支架设计 (支架厚度) 和部署对支架血栓发生性的影响.
- 为了将计算流体动力学与观察到的血栓事件相关联.
主要方法:
- 使用定制设备进行药物排泄与裸金属支架的比较分析.
- 试验ex vivo流环实验,以评估血栓性.
- 在猪冠状动脉中的体内植入.
- 评估错位和重叠的支架配置.
- 用支架诱导的血液动力学计算建模.
主要成果:
- 与赤裸金属支架相比,药物/聚合物涂层均降低了血栓发生率 (0.65倍,P=0.011).
- 厚型支架 (162微米) 比薄型支架 (81微米) 更容易产生血栓,无论是ex vivo (1.5倍,P<0.001) 还是in vivo (1.6倍,P=0.004).
- 错位和重叠的裸金属支架显示出显著增加的血栓发生率 (分别为1.58-倍,P=0.001;和2.32倍,P<0.001).
- 薄型,聚合物涂层的支架在所有配置中表现出最低的血栓发生率.
结论:
- 药物/聚合物涂层本身不会增加急性支架凝固;它们减少血栓形成.
- 支架尺寸和相对于血管壁的部署是血栓发生率的关键决定因素.
- 薄型支架和最佳几何形状将血栓形成的风险降至最低,即使部署变化.
相关概念视频
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Site-Targeted Drug Delivery Systems: Polymeric Carriers
Polymeric carriers enhance targeted drug delivery by increasing efficacy while minimizing off-target effects. These carriers comprise a biodegradable polymeric backbone integrated with functional elements that enable targeting, improve physicochemical properties, and regulate drug release.Targeting MechanismsThe targeting ability of polymeric carriers is mediated by a homing device, which is a molecular recognition component designed to selectively bind to specific tissues or cells. Monoclonal...
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Biopharmaceutical Factors Influencing Drug Product Design: Overview
Rational drug product design integrates knowledge of the drug’s physicochemical properties, formulation components, manufacturing techniques, and intended route of administration. Each factor influences the drug’s performance, including how it is released, absorbed, and eliminated in the body.The physicochemical properties of a drug—such as solubility, stability, and particle size—affect its compatibility with excipients and the choice of dosage form. Excipients, though pharmacologically...

