Salzman E W, Brier-Russell D, Lindon J, Merrill E W
Philos Trans R Soc Lond B Biol Sci. 1981 Aug 18;294(1072):389-98. doi: 10.1098/rstb.1981.0115.
Contact of blood with a foreign surface activates platelets and leads to their consumption. This property is shared by most non-biological materials, including air, but can be reduced by an optimal balance of hydrophobicity and hydrophilicity, minimal capacity for hydrogen bonding, avoidance of crystallinity, maintenance of polymer backbone mobility, and other manipulations of the chemistry of the polymer. None the less, no totally non-thrombogenic artificial surface has been developed. Attention has therefore turned to suppression of platelet-surface interaction by drugs that alter platelet function. Agents that block cyclo-oxygenase inhibit surface-induced secretion and aggregation but have no effect on platelet adhesion. Drugs that increase platelet cyclic AMP levels have a dose-related effect, which at high concentrations can eliminate adhesion to surfaces. The most successful agent, prostacyclin, has achieved total protection of platelets during cardiopulmonary bypass, with preservation of normal platelet number and function. Associated vasodilatation is a notable side effect, and hypotension may prove to be a significant problem in clinical practice. The development of more selective analogues with minimal vasodepressor activity is to be encouraged.
血液与异物表面接触会激活血小板并导致其消耗。大多数非生物材料（包括空气）都有这种特性，但通过疏水性和亲水性的最佳平衡、最小的氢键形成能力、避免结晶性、保持聚合物主链的流动性以及对聚合物化学性质的其他操作，可以降低这种特性。尽管如此，尚未开发出完全不产生血栓的人工表面。因此，注意力转向了通过改变血小板功能的药物来抑制血小板与表面的相互作用。阻断环氧化酶的药物可抑制表面诱导的分泌和聚集，但对血小板黏附没有影响。提高血小板环磷酸腺苷水平的药物具有剂量相关效应，在高浓度时可消除对表面的黏附。最成功的药物前列环素，在体外循环期间实现了对血小板的完全保护，同时保持了正常的血小板数量和功能。相关的血管扩张是一个明显的副作用，低血压在临床实践中可能是一个重大问题。鼓励开发具有最小血管舒张活性的更具选择性的类似物。
