Table 3 Three essentials in normal hemostasis
(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) |