ISSN : 2146-3123
E-ISSN : 2146-3131

Drug Eluting Vein Graft with Acetylsalicylic Acid–ticagrelor–unfractionated Heparin Complex Inhibits Early Graft Thrombosis
Ercan Akşit1, Tolga Kurt2, Başak Büyük3, Ömer Çokkalender4
1Department of Cardiology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
2Department of Cardiovascular Surgery, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
3Department of Histology and Embryology İzmir Demokrasi University School of Medicine, İzmir, Turkey
4Clinic of Cardiovascular Surgery, 25 Aralık State Hospital, Gaziantep, Turkey
DOI : 10.4274/balkanmedj.galenos.2020.2019.1.128

Background: Bypass graft surgery remains an important treatment option for left main and multi-vessel coronary artery disease. Approximately 2% of saphenous vein grafts are lost immediately after the coronary artery bypass graft operations, and 12% are lost in the first month due to thrombosis.
Aims: The aim of this study is to administer one anticoagulant and two antiplatelet agents in a way that locally affects the vein graft before the bypass operation and to thereby analyse their effects on early graft thrombosis.
Study Design: Animal experimentation.
Methods: Since ticagrelor was used locally for the first time in this study, its efficacy with combinations of other drugs [only Acetylsalicylic acid (ASA), ASA and Ticagrelor, ASA-Ticagrelor-Unfractionated Heparin (UFH)] was examined on rats including control (untreated) and sham (pluronic gel) group (n=14 for each group). Before the tunica adventitia layer of the femoral veins was bypassed to the femoral artery, it was coated with the drug-eluting pluronic F-127 gel. The presence or absence of thrombus in the vein graft samples was recorded under light microscopy. In vein graft preparations where thrombus was detected, thrombus area (µm2) was calculated using Axiovision software. Immunohistochemical staining was performed with the anti-rat von Willebrand factor (VWF) polyclonal antibody kit.
Results: In terms of presence of thrombus in the preparations, the number of the preparations containing thrombus was significantly lower in the ASA+Ticagrelor+UFH group compared to the ASA, control and sham groups, according to the comparisons made on the 1st and 3rd day (p=0.001 and p=0.02). VWF staining was significantly lower in the ASA+Ticagrelor+UFH group compared with that in the other groups on the 3rd day (p=0.005).
Conclusion: Locally effective ASA-Ticagrelor-UFH complex has been shown to significantly reduce thrombus formation in vein grafts in this experimental model. Local administration of these drugs, which are routinely administered orally just before stent implantations, on the vein graft before the bypass is performed can prevent the loss of vein grafts due to thrombus, thereby reducing the mortality and morbidity of these patients.

Keywords : Acetyl salicylic acid, heparin, hydrogel, thrombosis, ticagrelor, vein bypass graft
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