Skip to main content

Table 3 Three essentials in normal hemostasis

From: Disseminated intravascular coagulation: new identity as endotheliopathy-associated vascular microthrombotic disease based on in vivo hemostasis and endothelial molecular pathogenesis

(1) Hemostatic principles
(1) Hemostasis can be activated only by vascular injury.
(2) Hemostasis must be activated through ULVWF path and/or TF path.
(3) Hemostasis is the same process in both hemorrhage and thrombosis.
(4) Hemostasis is the same process in both arterial thrombosis and venous thrombosis.
(5) Level of vascular damage (ECs/SET/EVT) determines different clinical phenotypes of hemorrhagic disease and thrombotic disorder.
(2) Major participating components
Components Origin Mechanism involved
(1) ECs/SET/EVT Blood vessel wall/EVT Protective barrier in hemostasis
(2) ULVWF ECs Endothelial exocytosis; microthrombogenesis
(3) Platelets Circulation Adhesion to ULVWF strings; microthrombogenesis
(4) TF SET and EVT Release from tissue due to vascular injury; fibrinogenesis
(5) Coagulation factors Circulation Activation of coagulation factors; fibrinogenesis
(3) Vascular injury and hemostatic phenotypes
Injury-induced damage Involved hemostatic path Level of intravascular injury and thrombosis phenotypes
(1) ECs ULVWF Level 1 damage – microthrombosis (e.g., TIA [focal]; Heyde syndrome [local]; EA-VMTD/“DIC” [disseminated])
(2) ECs/SET ULVWF + sTF Level 2 damage – macrothrombosis (e.g., AIS; DVT; PE; AA)
(3) ECs/SET/EVT ULVWF + eTF Level 3 damage – macrothrombosis with hemorrhage (e.g., THS; HMI)
(4) EVT alone eTF Level E damage – fibrin clot disease (e.g., AHS [e.g., SDH; EDH]; ICH; organ/tissue hematoma)
Hemostatic phenotypes Causes Genesis of phenotypes
(1) Hemorrhage External bodily injury Trauma-induced external bleeding (e.g., accident; assault; self-inflicted injury)
(2) Hematoma Internal EVT injury Obtuse trauma-induced bleeding (e.g., tissue and cavitary hematoma; hemarthrosis)
(3) Thrombosis Intravascular injury Intravascular injury (e.g., atherosclerosis; indwelling vascular device; surgery; procedure)
  1. Abbreviations: AA Aortic aneurysm, AIS Acute ischemic stroke, AHS Acute hemorrhagic syndrome, ““DIC” False disseminated intravascular coagulation, DVT Deep vein thrombosis, ECs Endothelial cells, EDH Epidural hematoma, EVT Extravascular tissue, HMI Hemorrhagic myocardial infarction, ICH Intracerebral hemorrhage, PE Pulmonary embolism, SDH Subdural hematoma, SET Subendothelial tissue, TF Tissue factor, eTF Extravascular TF, sTF Subendothelial TF, THS Thrombo-hemorrhagic stroke, TIA Transient ischemic attack, ULVWF Unusually von Willebrand factor multimers, VMTD Vascular microthrombotic disease, EA-VMTD/DIT Endotheliopathy-associated vascular microthrombotic disease;