Objective-Blood compatibility of artificial surfaces depends on their immunogenic and thrombogenic properties.Collagen's weak antigenicity makes it an attractive candidate for stent coatings or fabrication of vascular grafts. However, the thrombogenic nature of collagen limits its application. We examined whether heparinization can make collagen more thromboresistant. Methods and Results-Collagen was heparinized by crosslinking collagen with extensively periodate oxidized heparin and/or by covalently bonding of mildly periodate oxidized heparin. Both ways of heparinization have no effect on platelet adhesion and could not abolish induction of platelet procoagulant activity. However, thrombin generation was completely prevented under static and flow conditions. The functionality of immobilized heparin was confirmed by specific uptake of antithrombin, 13.5Ϯ4.7 pmol/cm 2 and 1.95Ϯ0.21 pmol/cm 2 for mildly and heavily periodated heparin, respectively. Conclusions-These results indicate that immobilization of heparin on collagen, even as a crosslinker, is a very effective way to prevent surface thrombus formation. These data encourage the application of heparinized collagen as stent-graft material in animal and eventually human studies. Key Words: collagen Ⅲ heparin Ⅲ thrombogenicity Ⅲ thrombosis Ⅲ blood flow C ardiovascular disease, including vascular stenosis, is still the leading cause of death in Western society. Obstructive atherosclerotic disease, causing angina pectoris or even myocardial infarction, is currently treated by the implantation of a stent or through bypass surgery. Unfortunately, attempts to implant vascular grafts with a small diameter are not successful because of thrombotic and inflammatory reactions. 1-6 Thus, to enhance blood compatibility, a surface has to be designed that is both anti-immunogenic and thromboresistant. Collagen has been widely used in medical applications, including skin replacement, bone substitutes, and artificial valves. 7,8 Recently, a number of investigators attempted to use modified collagen as a vascular graft material. 9 -12 Potential advantages of the natural biological polymer collagen are its weak antigenicity and high tensile strength, which can resist high arterial blood pressures. Furthermore, collagen is a suitable substrate for endothelial cell growth in vitro, 11 which makes its application as an artificial vessel even more attractive. Nevertheless, the prothrombotic properties of collagen 13 are a major drawback in its applicability in blood contacting devices.To make collagen more thromboresistant, Wissink et al 14 coupled the sulfated polysaccharide, heparin, to collagen. An in vitro assay showed that the immobilized heparin was functionally active as it accelerated the thrombinantithrombin (AT) reaction. In addition, this group demonstrated that crosslinking of collagen had an adverse effect on the antigenicity and degradation rate of collagen, but stimulated endothelial cell adhesion and proliferation. 11,12 The suitability of collagen as a vascular g...