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The biology of haemostasis and thrombosis 

The biology of haemostasis and thrombosis
The biology of haemostasis and thrombosis

Gilbert C. White

, Harold R. Roberts

, and Nigel S. Key

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date: 07 March 2021

Haemostasis—a component of the wound defence mechanism—is a process by which vessel wall components and platelets act in concert with procoagulant and anticoagulant proteins to form a plug of cells and cross-linked fibrin. The plug is later remodelled and replaced by new tissue as part of wound healing. These processes are very complex and involve highly controlled pathways of interaction between cells, glycans, and membrane-bound and soluble proteins of coagulation and fibrinolysis, as well as their cognate inhibitors. Thrombosis—this is an abnormal state leading to formation of a clot that partially or completely obstructs the flow of blood within the blood vessel; dislodgement leads to thromboembolism. To understand the biology of haemostasis and thrombosis, it is necessary to know the roles of the vessel wall, the platelets, the coagulation and fibrinolytic systems, and their respective inhibitors. Fibrinolysis and coagulation are interrelated: fibrin clots are normally lysed by plasmin locally released from plasminogen by the action of tissue plasminogen activator, and this process can be enhanced by some procoagulant factors (e.g. activated factor XII, and protein C). This system, so delicately controlled and normally maintained in a dynamic equilibrium, is strongly influenced by components involved in inflammatory and other defence mechanisms in the host. An integrated understanding of these processes offers the potential for improved means to predict the adverse complications of many diseases and ultimately to prevent their occurrence.

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