ANTITHROMBOTIC PROPERTIES PROTHROMBOTIC PROPERTIES Fig 5-5 Fig 5-6 THREE INFLUENCES OF THROMBOSIS Fig 5-8 Endothelial injury Alterations in normal blood flow Hypercoagulable states Hypercoagulable states Hypercoagulable states White thrombus Mixed thrombus Red thrombus Fibrin thrombus Absorption Organization Calcification Detachment Ischemia Congestion Heart valve disease DIC Embolism * * Thrombosis Thrombus Thrombi Inhibition of platelet aggregation: PGI2, NO, ADPase Anticoagulant -binding and inhibition of thrombin: Antithrombin III acceleration by heparin-like molecules, thrombomodulin activation of protein C/S, ?2-macroglobulin. Fibrinlysis: Tissue plasminogen activator (tPA) Simulation of platelet aggregation (adhesion): von Willebrand factor, platelet-activating factor. Procoagulation factors: Tissue factor, binding factors IXa and Xa, Factor V. Inhibition of fibrinolysis: t-PA inhibitor. Endothelial injury (most important). Alone can induce thrombosis. Alterations in normal flow. Hypercoagulability. When the last two are both present, endothelial injury is not requisite. Ulcerative atherosclerosis Transmural myocardial infarction Vasculitis Trauma Radiation Bacterial toxins Platelets activated by contact with endothelium. Slowed flow retards dilution of activated clotting factors and hepatic clearance. Stasis or turbulence retards the inflow of inhibitors. Turbulence may induce endothelial injury Primary (genetic): Antithrombin III deficiency Protein C deficiency Protein S deficiency Other combined deficiency Secondary (acquired): High risk: Prolonged bed rest or immobilization. Myocardial infarction. Tissue damage (surgery, fractures, burns). Cardiac failure. Cancer. Acute leukemia. DIC. Myoproliferative disorders. Prosthetic cardiac valves. Homocystinuria. Thrombotic thrombocytopenia. Secondary (acquired): Low risk:
Atrial fibrillation. Cardiomyopathy. Nephrotic syndrome. Hyperlipidemia. Late pregnancy/postdelivery. Oral contraceptives. Lupus anticoagulant. Sickle cell anemia. Smoking. Thrombocytosis. Types of thrombus Fate of thrombus Effects of thrombosis * * *
