Coagulation, also referred to as blood clotting, is a process through which blood forms solid clots. It is part of the hemostasis system, which also includes vasoconstriction and platelet aggregation. The coagulation process involves a series of tightly regulated biochemical reactions that ultimately lead to the formation of a stable blood clot. Proper coagulation is critical for maintaining vascular integrity and preventing hemorrhage.
Extrinsic pathway: The extrinsic pathway is induced by tissue factor (TF), which is secreted by injured endothelial cells. TF binds to and activates Factor VII, forming a complex called TF-FVIIa. TF-FVIIa then promotes the alteration of factor X to Xa.
Intrinsic pathway: The intrinsic pathway is activated when Factor XII comes into contact with exposed collagen at the site of injury. This interaction activates multiple clotting factors, including Factors XI, IX, and VIII. Ultimately, Factor X is activated, connecting the intrinsic and common pathways.
Common pathway: Factor X is activated through either the extrinsic or intrinsic pathway by TF-FVIIa complexes. Once activated, Factor X forms a complex with Factor V, calcium ions, and phospholipids known as the prothrombinase complex. The prothrombinase complex converts prothrombin to thrombin. Thrombin then cleaves fibrinogen into fibrin, which polymerizes to form a stable blood clot.
Fig.1 Overview of coagulation cascade.1
Coagulation is crucial for hemostasis, preventing excessive bleeding upon injury by forming blood clots. Besides, coagulation is involved in a variety of physiological activities, including wound healing and tissue repair. However, dysregulation of the coagulation system can lead to thrombosis, where blood clots form inappropriately within blood vessels, potentially causing serious conditions like deep vein thrombosis, pulmonary embolism, or stroke. On the other hand, deficiencies or abnormalities in clotting factors can result in bleeding disorders such as hemophilia or von Willebrand disease.
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Procoagulants: These substances promote blood clot formation by facilitating the conversion of fibrinogen to fibrin, which forms the meshwork of the clot.
Anticoagulants: These substances inhibit blood clot formation or promote clot dissolution, preventing clotting from spreading uncontrollably.
Fibrinolytic factors: These substances facilitate the dissolution of blood clots once hemostasis is achieved, preventing clot formation from obstructing blood flow.
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