Updated: 7/18/2018

Thrombogenesis

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Overview
  • Always a balance between pro-aggregation and anti-aggregation forces
  • Formation of a platelet plug occurs in four main stages
    • Adhesion 
      • platelet Gp1b receptor binding to exposed subendothelial collagen
        • mediated by vWF
    • Aggregation
      • vasoconstriction results in decreased blood flow
        • mediated by activated platelets which synthesize TxA2 by cyclooxygenase I enzymes
          • COXI inhibited by aspirin which results in ↓ aggregation
      • PGI2 and NO released by endothelial cells are natural aggregation inhibitors by vasodilating vessels
    • Swelling
      • inter-platelet binding via fibrinogen cross links to GpIIb/IIIa receptors on platelet membrane
        • GpIIb/IIIa inserted on membrane by binding of ADP to platelet ADP receptors
      • once this step happens the bleeding stops and is the end of the "bleeding time" test
        • although clot has formed, it is unstable and easily disrupted
    • Maturation
      • fibrinogen is converted to fibrin with cross-linking to strengthen plug
      • Ca2+ also strengthens platelet plug

 

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