Medicus, Vol. 33 No. 1 Tromboembolije, 2024.
Review article
What We Need to Know About the Coagulation Process Today
Désirée Coen Herak
Abstract
The cell-based coagulation model has significantly enhanced previous knowledge up to the beginning of the 21st century and became a defining moment in the understanding of the hemostatic response of the organism after damage to the blood vessel wall, thus providing a better explanation of physiological hemostasis in vivo. New insights into the pathogenesis of thrombosis have shown that the mechanisms of physiological hemostatic response and thrombosis mutually differ, and as such need to be observed separately despite their shared elements – thrombin production and fibrin clot formation. Simply put, thrombosis can be defined as a pathological process characterized by a deviation from the physiological hemostatic response, in which only blood vessel injury can activate the clotting system, with the aim of stopping bleeding by the formation of a hemostatic clot. Research conducted over the past 15 years has shown that along with activation of tissue factor (TF) as the initial mechanism, activation of the contact system is an additional mechanism responsible for the formation of thrombin and fibrin in thrombosis. Coagulation factor XI becomes a central factor in the amplification phase of coagulation in thrombosis, given that it connects both activation mechanisms of coagulation, and has proven to be a necessary factor for maintaining the pro-coagulation signal and thrombus growth. Consistent with new findings, hemostatic mechanisms involved in the pathogenesis of thrombosis are even more complex than physiological hemostasis, whereby the dynamics and multifunctionality of the coagulation activation pathways in which the mechanisms are intertwined have been proven. Ultimately, this led to the development of new therapeutic approaches and a new generation of anticoagulant drugs whose application in the treatment of thrombosis is foreseeable in the upcoming years.
Keywords
hemostasis; thrombosis; cell-based coagulation model; tissue factor pathway; contact pathway
Hrčak ID:
321766
URI
Publication date:
24.10.2024.
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