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Antiplatelet Therapy and Vascular Grafts: Studies in a Baboon Ex Vivo Shunt

Antiplatelet Therapy and Vascular Grafts: Studies in a Baboon Ex Vivo Shunt Abstract • Antiplatelet therapy is currently recommended in an effort to improve patency rates of small-caliber vascular grafts. The effect of aspirin and heparin on acute platelet deposition was studied in a baboon ex vivo shunt. Two grafts, expanded polytetrafluoroethylene and knitted Dacron, were exposed to a flow rate of 25 mL/min after administration of aspirin or heparin. Indium 111–labeled platelet uptake by the grafts was determined over 2½ hours. The amount of platelet deposition in the treated groups was significantly less than that of controls after 2½ hours. There was no difference between the aspirin and heparin groups. The finding that heparin inhibited platelet deposition to a degree comparable with aspirin suggests that it may not be necessary to start antiplatelet therapy preoperatively. Intraoperative systemic heparinization will provide sufficient inhibition of platelet deposition. A protocol for perioperative antiplatelet therapy is outlined. (Arch Surg 1986;121:778-781) References 1. Chesebro JH, Fuster V, Elveback LR, et al: Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations . N Engl J Med 1984;310:209-214.Crossref 2. Green RM, Roedersheimer LB, DeWeese JA: Effects of aspirin and dipyridamole on expanded polytetrafluoroethylene patency . Surgery 1982;92:1016-1026. 3. Chesebro JH, Clements IP, Fuster V, et al: A platelet-inhibitor-drug trial in coronary-artery bypass operations: Benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency . N Engl J Med 1982;307:73-78.Crossref 4. Lorenz RL, Schacky CV, Weber M, et al: Improved aorto-coronary bypass patency by low-dose aspirin (100 mg daily) . Lancet 1984;1:1261-1264.Crossref 5. Edwards WH, Mulherin JL, Jenkins JM: The role of antiplatelet drugs in carotid reconstructive surgery . Ann Surg 1985;201:765-770.Crossref 6. Kohler TR, Kaufman JL, Kacoyanis G, et al: Effect of aspirin and dipyridamole on the patency of lower extremity bypass grafts . Surgery 1984;96:462-466. 7. Pantely GA, Goodnight SH, Rahimtoola SH, et al: Failure of antiplatelet and anticoagulant therapy to improve patency of grafts after coronary-artery bypass . N Engl J Med 1979;301:962-966.Crossref 8. McEnany MT, Salzman EW, Mundth ED, et al: The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts . J Thorac Cardiovasc Surg 1982;83:81-89. 9. Eldrup-Jorgensen J, Mackey WC, Connolly RJ, et al: Evaluation of arterial prostheses in baboon ex vivo shunt: The effect of graft material and flow on platelet deposition . Am J Surg 1985;150:185-190.Crossref 10. Mackey WC, Keough EM, Connolly RJ, et al: A baboon flow-regulated shunt for the study of small-caliber vascular grafts . J Surg Res 1984;37: 112-118.Crossref 11. Hampton JW, Mathews C: Similarities between baboon and human clotting . J Appl Phys 1966;21:1713-1716. 12. Dodds WJ: Platelet function in animals: Species specificities , in de Gaetano G, Garattini S (eds): Platelets: A Multidisciplinary Approach . New York, Raven Press, 1978, pp 45-59. 13. Ramberg K, Keough EM, Callow AD, et al: Indium 111–labeled platelet imaging of endothelial cell seeded small-caliber synthetic grafts in the baboon . ASAIO J 1985;8:95-98. 14. Yates SG, Barros D'Sa AA, Berger K, et al: The preclotting of porous arterial prostheses . Ann Surg 1978;188:611-622.Crossref 15. Nichols WL, Gerrard JM, Didisheim P: Platelet structure, biochemistry and physiology , in Poller L (ed): Recent Advances in Blood Coagulation . Bath, England, The Pitman Press, 1981, pp 1-40. 16. Walsh PN: Platelets, blood coagulation, and hemostasis , in Sherry S, Scriabine A (eds): Platelets and Thrombosis . Baltimore, University Park Press, 1974, pp 23-43. 17. Hoak JC: Mechanisms of action: Aspirin . Thromb Res 1983;23( (suppl 4) ):47-51.Crossref 18. Smith JB, Araki H, Lefer AM: Thromboxane A2 prostacyclin and aspirin: Effects on vascular tone and platelet aggregation . Circulation 1980;62:19-25.Crossref 19. Oblath RW, Buckley FO, Green RM, et al: Prevention of platelet aggregation to prosthetic vascular grafts by aspirin and dipyridamole . Surgery 1978;84:37-44. 20. Zammit M, Kaplan S, Sauvage LE, et al: Aspirin therapy in small-caliber arterial prostheses: Long-term experimental observations . J Vasc Surg 1984;1:839-851.Crossref 21. Hagen PO, Zhong-Gao W, Mikat EM, et al: Antiplatelet therapy reduces aortic intimal hyperplasia distal to small-diameter vascular prostheses (PTFE) in nonhuman primates . Ann Surg 1982;195:328-339.Crossref 22. Salzman EW: Aspirin to prevent arterial thrombosis . N Engl J Med 1982;307:113-115.Crossref 23. Shepard A, Eldrup-Jorgensen J, Keough E, et al: Endothelial cell seeding of small-caliber synthetic grafts in the baboon. Surgery, in press. 24. Cronberg S, Robertson B, Nilsson M, et al: Suppressive effect of dextran on platelet adhesiveness . Thromb Haemost 1966;16:384-389. 25. Rutherford RB, Jones DN, Bergentz SE, et al: The efficacy of dextran 40 in preventing early post-operative thrombosis following difficult lower extremity bypass . J Vasc Surg 1984;1:765-773.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Antiplatelet Therapy and Vascular Grafts: Studies in a Baboon Ex Vivo Shunt

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American Medical Association
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Copyright © 1986 American Medical Association. All Rights Reserved.
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0004-0010
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1538-3644
DOI
10.1001/archsurg.1986.01400070044009
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Abstract

Abstract • Antiplatelet therapy is currently recommended in an effort to improve patency rates of small-caliber vascular grafts. The effect of aspirin and heparin on acute platelet deposition was studied in a baboon ex vivo shunt. Two grafts, expanded polytetrafluoroethylene and knitted Dacron, were exposed to a flow rate of 25 mL/min after administration of aspirin or heparin. Indium 111–labeled platelet uptake by the grafts was determined over 2½ hours. The amount of platelet deposition in the treated groups was significantly less than that of controls after 2½ hours. There was no difference between the aspirin and heparin groups. The finding that heparin inhibited platelet deposition to a degree comparable with aspirin suggests that it may not be necessary to start antiplatelet therapy preoperatively. Intraoperative systemic heparinization will provide sufficient inhibition of platelet deposition. A protocol for perioperative antiplatelet therapy is outlined. (Arch Surg 1986;121:778-781) References 1. Chesebro JH, Fuster V, Elveback LR, et al: Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations . N Engl J Med 1984;310:209-214.Crossref 2. Green RM, Roedersheimer LB, DeWeese JA: Effects of aspirin and dipyridamole on expanded polytetrafluoroethylene patency . Surgery 1982;92:1016-1026. 3. Chesebro JH, Clements IP, Fuster V, et al: A platelet-inhibitor-drug trial in coronary-artery bypass operations: Benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency . N Engl J Med 1982;307:73-78.Crossref 4. Lorenz RL, Schacky CV, Weber M, et al: Improved aorto-coronary bypass patency by low-dose aspirin (100 mg daily) . Lancet 1984;1:1261-1264.Crossref 5. Edwards WH, Mulherin JL, Jenkins JM: The role of antiplatelet drugs in carotid reconstructive surgery . Ann Surg 1985;201:765-770.Crossref 6. Kohler TR, Kaufman JL, Kacoyanis G, et al: Effect of aspirin and dipyridamole on the patency of lower extremity bypass grafts . Surgery 1984;96:462-466. 7. Pantely GA, Goodnight SH, Rahimtoola SH, et al: Failure of antiplatelet and anticoagulant therapy to improve patency of grafts after coronary-artery bypass . N Engl J Med 1979;301:962-966.Crossref 8. McEnany MT, Salzman EW, Mundth ED, et al: The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts . J Thorac Cardiovasc Surg 1982;83:81-89. 9. Eldrup-Jorgensen J, Mackey WC, Connolly RJ, et al: Evaluation of arterial prostheses in baboon ex vivo shunt: The effect of graft material and flow on platelet deposition . Am J Surg 1985;150:185-190.Crossref 10. Mackey WC, Keough EM, Connolly RJ, et al: A baboon flow-regulated shunt for the study of small-caliber vascular grafts . J Surg Res 1984;37: 112-118.Crossref 11. Hampton JW, Mathews C: Similarities between baboon and human clotting . J Appl Phys 1966;21:1713-1716. 12. Dodds WJ: Platelet function in animals: Species specificities , in de Gaetano G, Garattini S (eds): Platelets: A Multidisciplinary Approach . New York, Raven Press, 1978, pp 45-59. 13. Ramberg K, Keough EM, Callow AD, et al: Indium 111–labeled platelet imaging of endothelial cell seeded small-caliber synthetic grafts in the baboon . ASAIO J 1985;8:95-98. 14. Yates SG, Barros D'Sa AA, Berger K, et al: The preclotting of porous arterial prostheses . Ann Surg 1978;188:611-622.Crossref 15. Nichols WL, Gerrard JM, Didisheim P: Platelet structure, biochemistry and physiology , in Poller L (ed): Recent Advances in Blood Coagulation . Bath, England, The Pitman Press, 1981, pp 1-40. 16. Walsh PN: Platelets, blood coagulation, and hemostasis , in Sherry S, Scriabine A (eds): Platelets and Thrombosis . Baltimore, University Park Press, 1974, pp 23-43. 17. Hoak JC: Mechanisms of action: Aspirin . Thromb Res 1983;23( (suppl 4) ):47-51.Crossref 18. Smith JB, Araki H, Lefer AM: Thromboxane A2 prostacyclin and aspirin: Effects on vascular tone and platelet aggregation . Circulation 1980;62:19-25.Crossref 19. Oblath RW, Buckley FO, Green RM, et al: Prevention of platelet aggregation to prosthetic vascular grafts by aspirin and dipyridamole . Surgery 1978;84:37-44. 20. Zammit M, Kaplan S, Sauvage LE, et al: Aspirin therapy in small-caliber arterial prostheses: Long-term experimental observations . J Vasc Surg 1984;1:839-851.Crossref 21. Hagen PO, Zhong-Gao W, Mikat EM, et al: Antiplatelet therapy reduces aortic intimal hyperplasia distal to small-diameter vascular prostheses (PTFE) in nonhuman primates . Ann Surg 1982;195:328-339.Crossref 22. Salzman EW: Aspirin to prevent arterial thrombosis . N Engl J Med 1982;307:113-115.Crossref 23. Shepard A, Eldrup-Jorgensen J, Keough E, et al: Endothelial cell seeding of small-caliber synthetic grafts in the baboon. Surgery, in press. 24. Cronberg S, Robertson B, Nilsson M, et al: Suppressive effect of dextran on platelet adhesiveness . Thromb Haemost 1966;16:384-389. 25. Rutherford RB, Jones DN, Bergentz SE, et al: The efficacy of dextran 40 in preventing early post-operative thrombosis following difficult lower extremity bypass . J Vasc Surg 1984;1:765-773.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Jul 1, 1986

References

  • Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations
    Chesebro JH, Fuster V, Elveback LR, et al
  • Effects of aspirin and dipyridamole on expanded polytetrafluoroethylene patency
    Green RM, Roedersheimer LB, DeWeese JA
  • A platelet-inhibitor-drug trial in coronary-artery bypass operations: Benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency
    Chesebro JH, Clements IP, Fuster V, et al
  • Improved aorto-coronary bypass patency by low-dose aspirin (100 mg daily)
    Lorenz RL, Schacky CV, Weber M, et al
  • The role of antiplatelet drugs in carotid reconstructive surgery
    Edwards WH, Mulherin JL, Jenkins JM
  • Effect of aspirin and dipyridamole on the patency of lower extremity bypass grafts
    Kohler TR, Kaufman JL, Kacoyanis G, et al
  • Failure of antiplatelet and anticoagulant therapy to improve patency of grafts after coronary-artery bypass
    Pantely GA, Goodnight SH, Rahimtoola SH, et al
  • The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts
    McEnany MT, Salzman EW, Mundth ED, et al
  • Evaluation of arterial prostheses in baboon ex vivo shunt: The effect of graft material and flow on platelet deposition
    Eldrup-Jorgensen J, Mackey WC, Connolly RJ, et al
  • A baboon flow-regulated shunt for the study of small-caliber vascular grafts
    Mackey WC, Keough EM, Connolly RJ, et al
  • Similarities between baboon and human clotting
    Hampton JW, Mathews C
  • Platelets: A Multidisciplinary Approach
    Dodds WJ
  • Indium 111–labeled platelet imaging of endothelial cell seeded small-caliber synthetic grafts in the baboon
    Ramberg K, Keough EM, Callow AD, et al
  • The preclotting of porous arterial prostheses
    Yates SG, Barros D'Sa AA, Berger K, et al
  • Recent Advances in Blood Coagulation
    Nichols WL, Gerrard JM, Didisheim P
  • Platelets and Thrombosis
    Walsh PN
  • Mechanisms of action: Aspirin
    Hoak JC
  • Thromboxane A2 prostacyclin and aspirin: Effects on vascular tone and platelet aggregation
    Smith JB, Araki H, Lefer AM
  • Prevention of platelet aggregation to prosthetic vascular grafts by aspirin and dipyridamole
    Oblath RW, Buckley FO, Green RM, et al
  • Aspirin therapy in small-caliber arterial prostheses: Long-term experimental observations
    Zammit M, Kaplan S, Sauvage LE, et al
  • Antiplatelet therapy reduces aortic intimal hyperplasia distal to small-diameter vascular prostheses (PTFE) in nonhuman primates
    Hagen PO, Zhong-Gao W, Mikat EM, et al
  • Aspirin to prevent arterial thrombosis
    Salzman EW
  • Suppressive effect of dextran on platelet adhesiveness
    Cronberg S, Robertson B, Nilsson M, et al
  • The efficacy of dextran 40 in preventing early post-operative thrombosis following difficult lower extremity bypass
    Rutherford RB, Jones DN, Bergentz SE, et al