Antithrombotic Effect of Ticlopidine-HCI in Microvascular Anastomoses

Keimyung Medical Journal 1988;7(1):50-57.

미세혈관문합때 염산 Ticlopidine의 항혈전 효과

전종완; 강진성

Abstract

Recent progress in microvascular surgery has opened new clinical possibilities in tissue transplantation and replantation by direct anastomoses of vessels less than one mm in external diameter. However; a large obstacle still remains in microsurgery; that is; occlusion of the anastomosis site by thrombosis which is mainly composed of platelets. Many anticoagulants and topical vasodilatic agents such as heparin; aspirin; persantin; coumarin and magnesium sulfate have been used to solve this problem. Heparin inhibits the conversion of prothrombin to thrombin and Factors T; K; 2. Aspirin inhibits collagen-induced platelet aggregation whereas the primary action of persantin is to inhibit ADP-induced platelet aggregation and the release reaction of platelets. Currently; ticlopidine-HCI which is known to inhibit the platelet aggregation to ADP; collagen and epinephrine; is widely in use as an effective anticoagulant for the patients of atherosclerosis; hemodialysis and subarachnoid hemorrhage. Animal study was carried out for the ticlopidine-HCI to investigate the possibility of this agent to be used as a choice of anticoagulant in microvascular surgery. One hundred and twenty rats were divided into 3 groups. Group A was the control groups. Aspirn and persantin were given orally in group B. Ticlopidine-HCI was given orally in group C. A femoral artery in one inguinal region and one femoral vein in the other side were severed and then were anastomosed with 10-0 nylon. The wounds were closed with 4?0 black silk. The patency was confirmed grossly and microscopically at 20 minutes; 3 days and 3 weeks after anastomoses. The patency rates were as follows: At 20 minutes after anastomoses; patency rates of arteries and viens were 100% in all groups. At 3 days after anastomoses; in the control group the patency rates of arteries and veins 95% and 85% respectively. Group B (aspirin-persantin) were 100% and 90% each. Compared with these; the patency rates of group C (ticlopidine) were better; all of the arteries and veins were patent. At 3 weeks after anastomoses; the patency rates of arteries were 90% and veins were 80% in the control group. Arteries were 95% and veins were 90% in group B; whereas arteries were 100% and veins were 95% in group C. Therefore; it is concluded that the ticlopidine can be used in microvasular surgery as an anticoagulant of choice.