血栓形成与抗栓治疗PPT参考幻灯片.ppt

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. * IIa因为外源性途径形成少量IIa，继续激活XIa、VIIIa、Va因子。因个因子可不停激活 触发，少量IIa 激活，放大凝血瀑布，形成大量IIa 纤维蛋白形成 XIIa因子如果去掉的话，血液抽出来仍然不凝。当血液和外界异物接触时，形成的血栓启动