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Updated: Jul 18 2018


  • 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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