Procoagulant Activity in Hemostasis and Thrombosis

Abstract

Virchow’s triad is traditionally invoked to explain pathophysiologic mechanisms leading to thrombosis, alleging concerted roles for abnormalities in blood composition, vessel wall components, and blood flow in the development of arterial and venous thrombosis. Given the tissue-specific bleeding observed in hemophilia patients, it may be instructive to consider the principles of Virchow’s triad when investigating mechanisms operant in hemostatic disorders as well. Blood composition (the function of circulating blood cells and plasma proteins) is the most well-studied component of the triad. For example, increased levels of plasma procoagulant proteins such as prothrombin and fibrinogen are established risk factors for thrombosis, whereas deficiencies in plasma factors VIII and IX result in bleeding (hemophilia A and B, respectively). Vessel wall (cellular) components contribute adhesion molecules that recruit circulating leukocytes and platelets to sites of vascular damage, tissue factor, which provides a procoagulant signal of vascular breach, and a surface upon which coagulation complexes are assembled. Blood flow is often characterized by two key variables: shear rate and shear stress. Shear rate affects several aspects of coagulation, including transport rates of platelets and plasma proteins to and from the injury site, platelet activation, and the kinetics of fibrin monomer formation and polymerization. Shear stress modulates adhesion rates of platelets and expression of adhesion molecules and procoagulant activity on endothelial cells lining the blood vessels. That no one abnormality in any component of Virchow’s triad fully predicts coagulopathy a priori suggests coagulopathies are complex, multifactorial and interactive. In this review, we focus on contributions of blood composition, vascular cells, and blood flow to hemostasis and thrombosis, and suggests cross-talk among the three components of Virchow’s triad is necessary for hemostasis and determines propensity for thrombosis or bleeding. Investigative models that permit interplay among these components are necessary to understand the operant pathophysiology, and effectively treat and prevent thrombotic and bleeding disorders.

Clinical Significance of Peripheral Endothelial Function for Left Atrial Blood Stagnation in Nonvalvular Atrial Fibrillation Patients With Low-to-Intermediate Stroke Risk

“…31 Virchow's triad traditionally explains a pathophysiologic mechanism of thrombus formation, and the triad includes abnormalities in blood composition, vessel wall components and blood flow. 35 In the present study, the occurrence of SEC was independently associated with LAVI, LAAV and RHI, suggesting that endothelial dysfunction was an important determinant of SEC in addition to LA remodeling and low LAA flow.…”

Noninvasive Assessment of Coronary Arteries in Patients with Hematologic Disorders

“…The first factor is represented by hypercoagulability, which is very common in myeloproliferative diseases such as leukemia, lymphoma, essential thrombocythemia, and polycythemia vera. 29 The second factor is represented by the mechanical injury of the arterial wall, which can occur in artery catheterization or due to circulating leukocytes and platelets in blood stream. [29][30][31] In 2008, Ruggeri et al presented the results of a large study that found an increased risk of excessive bleeding (7.3%) and vascular occlusion (7.7%) in patients with multiple personality disorder and thrombocytosis.…”

“…29 The second factor is represented by the mechanical injury of the arterial wall, which can occur in artery catheterization or due to circulating leukocytes and platelets in blood stream. [29][30][31] In 2008, Ruggeri et al presented the results of a large study that found an increased risk of excessive bleeding (7.3%) and vascular occlusion (7.7%) in patients with multiple personality disorder and thrombocytosis. 32 Vidwan et al reported the results of a retrospective study on 3,466 patients undergoing coronary angiography, in which they found significant correlations between the risk of bleeding, vascular complications, and elevated platelet counts.…”

Venous Thromboembolism and Robotic Surgery: Need for Prophylaxis and Review of Literature

“…Further research is required validating the risk factors for VTE in robotic surgeries. Venous stasis (part of the Virchow`s triad [21]) is one of the most important factors in the development of thromboembolism. Theoretically, prolonged pneumoperitoneum can increase the intra-abdominal pressures and compress the vessels.…”