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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:1729.)
© 2006 American Heart Association, Inc.

Brief Reviews

Flow Effects on Coagulation and Thrombosis

James J. Hathcock

From the Department of Medicine, Mt. Sinai School of Medicine, New York, NY.

Correspondence to James J. Hathcock, Department of Medicine, Box 1269, Mt. Sinai School of Medicine, One Gustave Levy Pl, New York, NY 10029. E-mail James.Hathcock{at}mssm.edu

Series Editor: Yale Nemerson
Regulation of Coagulation
ATVB In Focus

Previous Brief Reviews in this Series:

•Jesty J, Beltrami E. Positive feedbacks of coagulation: their role in threshold regulation. 2005;25:2463–2469.
•Monroe DM, Huffman M. What does it take to make the perfect clot? 2006;26:41–48.
•Bach RR. Tissue factor encryption. 2006;26:456–461.

Thrombosis occurs in a dynamic rheological field that constantly changes as the thrombus grows to occlusive dimensions. In the initiation of thrombosis, flow conditions near the vessel wall regulate how quickly reactive components are delivered to the injured site and how rapidly the reaction products are disseminated. Whereas the delivery and removal of soluble coagulation factors to the vessel is thought to occur via classic convection–diffusion phenomena, the movement of cells and platelets to the injured wall is strongly augmented by flow-dependent cell–cell collisions that enhance their ability to interact with the wall. In addition, increased shear conditions have been shown to activate platelets, alter the cellular localization of proteins such as tissue factor (TF) and TF pathway inhibitor, and regulate gene production. In the absence of high shearing forces, red cells, leukocytes, and platelets can form stable aggregates with each other or cells lining the vessel wall, which, in addition to altering the biochemical makeup of the aggregate or vessel wall, effectively increases the local blood viscosity. Thus, hemodynamic forces not only regulate the predilection of specific anatomic sites to thrombosis, but they strongly influence the biochemical makeup of thrombi and the reaction pathways involved in thrombus formation.

Thrombosis occurs in a dynamic rheological field where flow conditions regulate the transport of coagulation factors, inhibitors, and cells. Hemodynamic forces regulate not only the predilection of specific anatomic sites to thrombosis but strongly influence the biochemical makeup of thrombi and the reaction pathways involved in thrombus formation.

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