Interactions of synthetic and natural surfaces with blood in the physiological environment.

Efforts to explain blood compatibility with synthetic and natural surfaces based on a single parameter or a single biological test procedure have either been unsuccessful or led to misleading generalizations. The problem reflects the complex interdependence between material's properties, the composition and properties of blood, and in vivo biorheological conditions. Among the initial events that occur when materials contact blood is the very rapid adsorption of plasma proteins; this process effectively influences the subsequent interactions with the formed blood elements, especially the platelets with the proteinated surfaces. In the case of natural surfaces, when the endothelium is damaged, collagen may become exposed that may cause the activation, adhesion, and aggregation of platelets leading to thrombosis. Current evidence indicates that the platelet-aggregating ability of collagen depends on its "multimeric" or fibrillar structure, rather than on the activation of the platelet-bound enzyme system. Under normal conditions, the flowing blood is probably not in direct contact with endothelial cells that line the blood vessel walls, but with an adsorbed layer of plasma proteins. Should a formation of a multilayer of plasma proteins occur following the initial adsorption of a monolayer, this process could be influenced by changes in the solubility of the proteins, especially fibrinogen, the solubility of which is quite low in plasma. The hypothesis is proposed that such changes may be intimately related to the electrical properties of proteins present in the vascular wall and in blood. It is possible that these properties play a much greater role in thrombogenesis and in the problem of blood compatibility than is currently appreciated. Considering synthetic polymers, a number of these have been prepared that exhibit little adverse effects on blood components and, at the same time, retain their physical properties for various periods of time in the physiological environment. These combined biological and physical properties make them useful for various prosthetic and other biomedical applications in surgery and therapy.