Abstract No. 505 - Battery-powered electrified conductive vascular access device minimizes fibrin sheath adhesion

Abstract

No. 505 Battery-powered electrified conductive vascular access device minimizes fibrin sheath adhesion D. Choi, A. Negussie, R. Seifabadi, N. O’Grady, L. Jiang, J. Lozier, H. Amalou, R. Chang, B. Wood; National Institutes of Health, Bethesda, MD; Johns Hopkins University School of Medicine, Baltimore, MD; National Institutes of Health, Ellicott City, MD Purpose: Vascular access devices (VADs) are widely used in acute and chronic high-risk settings such as for dialysis or therapies in hyper-coagulable patients. VADs are associated with a range of complications including thrombosis, central venous stenosis, infection, and development of fibrin sheaths with astronomical costs to the health care system. A fibrin sheath is a heterogeneous matrix of cells and debris that forms a circumferential sleeve around the surface of VADs and often remains intact within the lumen of the vein after removal of the catheters. Therapeutic options include endoluminal thrombolytic therapy and percutaneous mechanical stripping, and prophylactic options like flushing do not guarantee avoiding development of fibrin sheath encasement. The purpose of this study is to study the ability of micro electric current in a custom conductive catheter to minimize fibrinsheath adhesion on VAD surfaces. Materials: A novel vascular catheter with a conductive distal tip was designed, custom fabricated, and used for this study. The catheters were incubated with human fibrinogen protein solution (1.0 mg/mL) for 2 hours at 37oC either with or without electric current (8μA). The catheters were washed and further incubated with Sheep Anti-Human Fibrinogen FITC antibody solution at 4oC overnight to visualize the fluorescence signals of fibrinogen. The catheter tips were qualitatively evaluated for protein adhesion using a Fluorescence Imaging System. For quantitative analysis, the catheter tips were sonicated in 7 mL of PBS buffer after washing the tips to detach loosely adhered fibrinogen protein. Signal intensities of fibrinogen adhered to electrified catheter and control were blindly compared using fluorescence spectroscopy at λexc/λemi of 490/520 nm. Results: Use of electric current to the conductive catheter reduced adherent fibrinogen by 39% compared to control. Qualitative analysis using fluorescent microscopy demonstrated catheter exposed to electric current had less signal compared to the control. Conclusions: In line with the inhibition of bacterial colonization previously reported, the electrification of the conductive VAD with a battery reduced fibrin adhesion in an in vitro model. Educational Exhibit Abstract No. 506 Novel anticoagulants: navigating the periprocedural course and previewing the new horizon for reversal agents A. Klobuka, M. Krosin, N. Amesur, F. Bontempo; University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh Medical Center, Pittsburgh, PA Learning Objectives: Describe the current clinical use and relevant pharmacokinetics of both the direct oral thrombin and factor Xa inhibitors including dabigatran, rivaroxaban, apixaban, and edoxaban. Illustrate the effects, or lack thereof, on commonly monitored anti-coagulation parameters. Review guidelines regarding when to withhold and resume these medications when planning low, moderate, and high risk procedures. Describe current, if any, available techniques for emergent reversal. Preview three agents currently under development, idarucizumab, andexanet alfa, and PER977 for the reversal of both direct thrombin and factor Xa inhibitors. Background: Dramatic growth in the utilization of novel oral anticoagulant agents is supplanting warfarin in the treatment of a number of conditions including non-valvular atrial fibrillation and deep venous thrombosis, as well as for venous thromboembolism prophylaxis. Clinical Findings/Procedure Details: The direct thrombin inhibitor dabigatran as well as the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban are compared in terms of their current approved clinical indications, onset of action, effect on common coagulation parameters, time course for witholding periprocedurally (as dependent on creatinine clearance), and amenability to indirect strategies for emergent reversal including hemodialysis and the use of clotting factor concentrates. Three potential reversal agents, idarucizumab, andexanet alfa, and PER977 are all within various stages of the FDA approval pipeline and will be discussed in terms of their mechanisms of action, proposed use, and anticipated market release timeline. Conclusions: Given the frequent coincidence of the conditions for which novel anticoagulants are used among the particular subset of patients requiring common interventional procedures, knowledge of their use and comfort with the guidelines for their periprocedural management are crucial skills for any practicing Posters and Exhibits ’ JVIR S224 P os te rs an d Ex hi bi ts