Advances in Strategies and Mechanisms for the Construction of Medical Anticoagulation Coatings

ZHAO Yanan; GAO Jinliang

doi:10.16490/j.cnki.issn.1001-3660.2026.10.015

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Surface Technology ›› 2026, Vol. 55 ›› Issue (10) : 182-191. DOI: 10.16490/j.cnki.issn.1001-3660.2026.10.015

Functional Surfaces and Technology

Advances in Strategies and Mechanisms for the Construction of Medical Anticoagulation Coatings

ZHAO Yanan^1,2, GAO Jinliang^1,2,*

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Abstract

Due to some excellent properties including heat resistance, corrosion resistance and flexibility, medical polymers have become key materials for making medical devices such as cardiovascular stents, hemodialysis membranes, catheters, etc. However, formation of thrombus on surfaces of blood-contacting medical devices remains a major challenge for their safe usage in clinical practice at present. Therefore, developing new surface coatings with anticoagulant property is very important in the research field of biomaterials. The work aims to systematically summarize the formation mechanism of blood clots on surfaces of biological materials and strategies for designing various anticoagulant coatings with different principles and their limitations.
Firstly, the formation mechanism of blood-contacting medical devices associated thrombosis was described, including adsorption of plasma proteins, adhesion and aggregation of platelets, generation of thrombin, and activation of the complement system. Platelet adhesion, activation and aggregation were induced by the adsorbed proteins on surfaces of medical devices. Factor XII adsorbed to the surface was activated automatically. The resulting factor XIIa converted prekallikrein to kallikrein, which started the coagulation process and led to thrombin generation. In addition to causing fibrin to deposit on the surface, thrombin also promoted platelet activation. The platelet aggregates deposited on the surface were stabilized by fibrin strands, forming a platelet-fibrin thrombus. Kallikrein, thrombin, and other coagulation enzymes could activate the complement system, which further triggered a local inflammatory response. Leukocytes also stuck to the surface and became activated, contributing to both inflammation and thrombosis.
Secondly, some methods for preparing anticoagulant surfaces of medical materials were analyzed in detail. These methods were mainly divided into four categories: the construction of bioinert surfaces, the immobilization of bioactive molecules, the endothelialization of material surfaces, and the development of multi-target synergistic coatings. Bioinert coatings were constructed on surfaces of materials to minimize the interaction of proteins and cells with the surface while not causing changes in their shape or structure. Normally, such coating materials could exhibit good anticoagulant properties. Bioactive surface coatings were achieved by permanently immobilizing biologically active ingredients or drugs on surfaces of medical devices. Coatings with bioactive molecules could directly inhibit the coagulation cascade and prevent neointimal hyperplasia. Natural vascular endodermis played important roles in exerting anticoagulation and anti-intimal hyperplasia effects and maintaining the normal homeostasis of the vascular microenvironment. It is important to endothelialize the surfaces of implanted materials to overcome complications in clinical practice. Therefore, promoting the adhesion of endothelial cells (ECs) on the surface of cardiovascular materials is also one of the key strategies to avoid the side effect of thrombosis. Recently, by immobilizing two or more different substances on surfaces of medical materials, a kind of multi-target synergistic coating has been generated. As the multiple materials on the surfaces work together, the coating can effectively inhibit the adhesion of proteins and the activation of platelets, achieving a perfect anticoagulant effect.
Although great progress in construction of anticoagulant surfaces on blood-contact medical devices has been achieved in recent years, it must be pointed out that these strategies still face problems and challenges, such as reduced activity of immobilized biological molecules and insufficient binding strength between coatings and material surfaces. Therefore, future research should focus on improving the stability, universal applicability, and safety of the coatings. Research in this field could help reduce public health risks, lessen the medical burden, and contribute to the Healthy China initiative. Undoubtedly, this work is also of great significance to promote the development of anticoagulation materials.

Key words

blood-contacting medical devices / biomaterial-induced clotting / anticoagulation coating / construction strategy / hemocompatibility

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ZHAO Yanan, GAO Jinliang. Advances in Strategies and Mechanisms for the Construction of Medical Anticoagulation Coatings[J]. Surface Technology. 2026, 55(10): 182-191

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Funding

National Natural Science Foundation of China (82360406); Inner Mongolia Autonomous Region Key Research and Development and Transformation Program-Social Public Welfare Field Project (2025YFSH0072)