血栓形成机制与抗栓药物展望详解.ppt

* Current methods of thromboprophylaxis * Thrombi are composed of fibrin and blood cells. The relative proportion of one type of cell to another and to fibrin is influenced by hemodynamic factors; therefore, the proportions differ in arterial vs venous thrombosis. Arterial thrombi formed under conditions of high flow are composed mainly of platelet aggregates bound together by fibrin strands. The resulting thrombi are sometimes referred to as white thrombi because they have few red blood cells. These thrombi are usually flat, tightly adherent, and relatively small. Arterial thrombi usually occur in association with preexisting vascular disease, the most common of which is atherosclerosis. They produce clinical manifestations by inducing tissue ischemia, primarily through the obstruction of local blood flow. Venous thrombi form in areas of stasis and are composed of red cells with a large amount of interspersed fibrin and relatively fewer platelets. These red thrombi are large, friable casts of the venous channel with branching arms that may extend into tributary veins. Too often such thrombi have only a weak proximal attachment to the venous intima, usually at a valve or a bifurcation, and may detach and embolize to occlude downstream vessels. Venous thrombi usually occur in the lower limbs, particularly in the deep veins of the calf or thigh. They are usually silent, but produce acute symptoms if they cause inflammation of the vessel wall or obstruction to flow, damage the venous valves, or embolize into the pulmonary circulation. References Hirsh J, et al. Pathogenesis of Thrombosis. In: Hemostasis and Thrombosis: Basic Principles and Clinical Practice, 3rd ed. Coleman RW, Hirsh J, Marder VJ, Salzman EW (eds). Philadelphia: JB Lippincott Company;1994:1151-1163. 人体生理凝血系统包括凝血和抗凝两个方面，两者间的动态平衡是正常机体维持体内血液流动状态和防止血液丢失的关键。机体的正常止血，主要依赖于完整的血管壁结构和功能，有效的血小板质量和数量以及正常的血浆凝血因子。广义的血栓形成是指在活体的心脏或血管腔内，血液发生凝固或血液中的某些成分互相粘集，形成固体质块的过程。在体内，无论是生理性凝血还是动脉粥样硬化斑块破裂后形成的病理性血栓，本质上都是机体的一种防护性反