Heparin has been the mainstay of anti thrombic therapy in arterial repair procedures. With increasing use of synthetic patch angioplasty ( @entity736 [ @entity736 ] or Dacron, Medical Products, Flagstaff, AZ) to improve long-term patency and limit @entity384 , however, the use of heparin has been associated with @entity548 , resulting in time delay in the operating room to achieve hemostasis, as well as clinically significant @entity190 . Because of the multiple sites of action of heparin in the coagulation cascade, both intravascular (desired effect) and extravascular (untoward side effect) hemostasis are impaired. The authors therefore tested the hypothesis that selective inhibition of @entity5642 , without significant @entity73 , would prevent clotting intraluminally while preserving hemostasis at the suture line of the patch graft. The unique position of factor IX/IXa in the coagulation cascade renders its inhibition an ideal target in this setting. The authors prepared active site blocked factor IXa (IXai) using @entity49619 , and tested this hypothesis in a @entity95 aortotomy model with PTFE patch closure using either heparin (25 i.u./kg; n = 16) or IXai (300 micrograms/kg; n = 21). The infrarenal aorta was identified and isolated, the anti coagulant infused, aortic cross clamp placed, and aortotomy repaired with a 2 x 6 mm PTFE patch. After cross-clamp removal, @entity190 was measured and time to hemostasis was recorded. Compared with heparin, IXai resulted in significantly reduce @entity190 (6.97 +/- 4.4 g vs 2.72 +/- 2.51 g, respectively, p < 0.008), and time to hemostasis (2.94 +/- 0.77 min vs 2.0 +/- 0.63 min, respectively, p < 0.003). To assess long-term patency and @entity715 , 12 @entity95 (given heparin; n = 6 and IXai; n = 6) were observed for up to 2 months post-operatively. No differences were observed between @entity95 treated with heparin or IXai; 100% of the grafts were patent with no differences in degree of intimal @entity1373 by histologic analysis. Together, these data suggest that use of IXai in PTFE vascular repair will safely allow realization of the benefits of long-term patency and decreased @entity384 , while eliminating the intraoperative morbidity of needle hole bleeding.

Selective anticoagulation with active site blocked factor IXa in synthetic patch vascular repair results in decreased XXXX and operative time.

@entity548 :: ('MESH:D006470', 'Disease') :: ['excessive needle hole bleeding'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity384 :: ('MESH:D002311', 'Disease') :: ['aneurysmal dilation', 'aneurysmal dilatation'] @entity73 :: ('MESH:D003072', 'Disease') :: ['impairment of extravascular hemostasis'] @entity1373 :: ('MESH:D006965', 'Disease') :: ['hyperplasia'] @entity95 :: ('9986', 'Species') :: ['New Zealand rabbit', 'rabbits'] @entity5642 :: ('MESH:D004211', 'Disease') :: ['intravascular coagulation'] @entity736 :: ('CHEBI:53251', 'Chemical') :: ['PTFE', 'polytetrafluoroethylene'] @entity49619 :: ('MESH:C030824', 'Chemical') :: ['dansyl-Glu-Gly-Arg chloromethylketone'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombosis']
@entity190 :: (MESH:D006473,Disease) :: ['blood loss']
