Factors Affecting Thrombus Formation

According to Virchow's triad,5 there are three possible contributors to the formation of an abnormal clot (thrombus): vessel wall injury or inflammation, changes in the intrinsic properties of blood, and decrease in blood flow velocity (Figure 1).5-9 Atherosclerotic plaques, which are found in most major arteries, are the main substrate for thrombus formation.10 The atherosclerotic process can start even before birth11 with approximately 65% of children between 12 and 14 years of age having intimal alteration.12-14 The lipid core of the atherosclerotic lesion is rich in tissue factor, which initiates the clotting cascade upon plaque rupture.15 Other factors that affect thrombus formation include the degree of plaque disruption and the content of tissue factor in the plaque.16 Stenotic arteries and blood velocity also affect the platelet disposition and thrombus formation as they change the shear rate of flowing blood.17 Certain systemic risk factors are also associated with thrombus formation, for example, lipoprotein(a) has a similar structure to plasminogen, which may impair thrombolysis.18 Increased blood thrombogenicity is also associated with increased low-density lipoprotein (LDL).19 Poorly controlled diabetes mellitus results in glycosylation of collagen and protein, increasing the levels of plasma fibrinogen. Furthermore, smoking has been found to increase tissue factor levels in thrombotic plaques.10

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