Magnesium alloys are promising materials for biodegradable vascular stents because of their good biocompatibility and physical properties. The poly-β-hydroxybutyrate (PHB) coating with vascular endothelial growth factor and heparin was prepared on the surface of WE magnesium alloys by layer-by-layer self-assembly technique. In this study, the effects of magnesium alloys with bioactive drug coating on human umbilical vein endothelial cells (HUVECs) and blood compatibility were investigated. The results showed that magnesium alloys with bioactive drug coating could decrease platelet adhesion, platelet activation, hemolysis rate, fibrinogen adsorption and increase activated partial thromboplastin time, prothrombin time, dynamic clotting of magnesium alloys. In addition, magnesium alloys with bioactive drug coating did not alter cytoskeleton morphological features of HUVECs, promoted cell adhesion and cell growth, and inhibited cell apoptosis. Therefore, the magnesium alloys with bioactive drug coating can be considered as potential and degradable biomaterials for vascular stents.

Impact of a bioactive drug coating on the biocompatibility of magnesium alloys

Background: As the transcatheter aortic valve implantation (TAVI) procedure continues to advance, the post-procedure care needs of patients are also changing. This is a high-risk patient population and there is variation between levels of post-procedure care needs for each patient. Previously, at Imperial College NHS Trust, all patients had gone directly to level 3 care. Aim: The aim of the current work was to develop an assessment tool to predict the level of care required post procedure. Methods: A screening tool was implemented pre procedure to predict the level of care patients would require post procedure. Findings: The system correctly identified 94% of patients able to go to the coronary care unit (CCU) rather than requiring a cardiac intenstive care unit (CICU) bed. Conclusion: Levels of care required vary between patients undergoing TAVI; in the majority of cases, this can be predicted in advance by the procedure type, level of sedation and individual comorbidities of the patient. Further researc...

Care planning post transcatheter aortic valve implantation (TAVI)

As the clinical demand for blood-contacting materials increases, higher requirements are placed on their physicochemical properties, durability and hemocompatibility in vivo. In this work, a multiple functionalized material was developed through a facile modification process. Herein, polycarbonate urethane (PCU) surface was co-modified with polyethylene glycol (PEG) and bivalirudin (BVLD). PCU provides excellent physical and mechanical properties, PEG and BVLD, especially BVLD, enable the surface with outstanding anticoagulant capacity. Specifically, PCU surface was first treated with hexamethylene diisocyanate to introduce active isocyanate groups onto the surface, followed by hydroxy-PEG grafting to improve the hydrophilicity. Finally, BVLD was immobilized on the surface via Michael addition reaction to improve antithrombotic properties. Attenuated total reflection Fourier transforms infrared spectroscopy and UV spectrophotometers were used to confirm the modified surfaces. The hydrophilicity was characterized by static water contact angle measurement, the morphology of the modified surfaces was observed by scanning electron microscopy. Blood compatibility of the modified surfaces was characterized by the hemolysis rate, platelet adhesion assay and cell culture test. The results showed that the BVLD immobilized surface has excellent anticoagulant properties, good fibrin-bound thrombin inhibition, and good resistance against non-specific adhesion of proteins. Hence, the co-modification with PEG and BVLD was proved an encouraging strategy for improving hemocompatibility. 

Surface modification of polycarbonate urethane by grafting polyethylene glycol and bivalirudin drug for improving hemocompatibility

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ccd.28994

SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease

Comparison of the antiplatelet and antithrombotic effects of bivalirudin versus unfractionated heparin: A platelet substudy of the HEAT PPCI trial

Background HEAT-PPCI compared bivalirudin and heparin in patients undergoing primary percutaneous coronary intervention. All patients received pre-procedural oral anti-platelet therapy, initially prasugrel (Pr) with some use of clopidogrel (C). Later, routine therapy switched to ticagrelor (T) (Figure 1a). Methods During working hours, Multiple Electrode Aggregometry (MEA) was used to assess ADP-induced platelet aggregation at the end of the index procedure. The effect of P2Y12 agents on MACE and major bleeding outcomes was assessed in all patients. Multiple logistic regression was used to adjust for baseline differences. Results With MEA data from 469 patients, Pr therapy resulted in greater suppression of platelet aggregation - 1b. In the entire study population Pr therapy was associated with reduced MACE. After adjustment there were no significant differences in the rates of MACE or major bleeding - 1c. Conclusion Patients who received Pr (rather than C or T) had greater suppression of ADP-induced aggregation at the end of the procedure. After adjusting for baseline characteristics, these results were not associated with significant differences in clinical events.

13 Oral P2Y12 inhibitor therapy in heat-PPCI: results of a pre-specified sub-study examining early effects on platelet aggregation and clinical events

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Comparison of the antiplatelet and antithrombotic effects of bivalirudin versus unfractionated heparin: A platelet substudy of the HEAT PPCI trial

13 Oral P2Y12 inhibitor therapy in heat-PPCI: results of a pre-specified sub-study examining early effects on platelet aggregation and clinical events