Evaluation of the anti-thrombosis efficacy of MPC-based copolymer coatings in high coagulation risk blood

Blood-contacting devices provide dual risks of thrombosis and infection in clinical applications. Conventional anticoagulants cause adverse effects and exhibit inadequate stability in hypercoagulable states. In this study, we broke away from the traditional understanding that zwitterionic hydrophilic groups dominate anti-fouling properties. We synthesized a ternary copolymer (PMLT) from MPC, LMA, and TSMA to investigate hydrophilic group proportion effects on thrombosis resistance, especially in hypercoagulable blood. Simply increasing the density of phosphocholine (PC) groups in the coating resulted in the coating losing its anticoagulant efficacy in hypercoagulable blood. Conversely, the composition-optimized PMLT-12 coating maintained a stable biomimetic bilayer structure. It demonstrated low protein adsorption and high antibacterial activity under normal conditions. Crucially, PMLT-12 retained excellent anti-thrombotic performance in challenging environments, including blood containing elevated levels of calcium ions and lipopolysaccharides (LPS), and blood from a diabetic animal model. The covalently crosslinked network mediated by TSMA concurrently enhanced the mechanical stability of the coating. This study highlights the critical role of hydrophobic-hydrophilic balance in anticoagulant efficacy against high coagulation risk, providing a novel strategy for improving blood-contacting device surfaces.