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Parsi K, Exner T, Low J, Ma DDF, Joseph JE. In vitro Effects of Detergent Sclerosants on Clot Formation and Lysis. Eur J Vasc Endovasc Surg 2010: 41;267-77
Abstract
Objective: To investigate the in vitro effects of detergent sclerosants Sodium Tetradecyl Sulphate (STS) and Polidocanol (POL) on clot formation and lysis.
Materials and Methods: Clot kinetics were assessed in whole blood by thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®). Fibrinogen was measured by Clauss method in plasma and factor XIII (FXIII) by ELISA. Turbidity measurements were used to assess clot lysis in plasma, and fibrinolysis in non-cross-linked and cross-linked fibrin. D-dimer was measured by VIDASÒ, STA®Liatest® and AxSYM® assays.
Results: Strong clots were formed at low sclerosant concentrations (0.075%-0.1%). At mid-range concentrations (0.15% STS, 0.15%-0.3% POL), both agents inhibited the contribution of platelets to clot firmness and formed weak clots prone to lysis. At higher concentrations (STS ≥0.3%, POL ≥0.6%), clot formation was inhibited. STS destroyed FXIII at ≥0.15% and fibrinogen at ≥0.6%. Neither sclerosant had a significant effect on cross-linked fibrin but STS had a lytic effect on non-cross-linked fibrin. STS caused an artefactual elevation of D-dimer in the VIDAS® assay when fibrinogen was present.
Conclusion: Detergent sclerosants demonstrated a tri-modal effect on clot formation, initiating strong clots at low concentrations, weak clots at mid-range concentrations and preventing clot formation at higher concentrations. Neither agent had fibrinolytic activity.
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