Potential analytes for the diagnosis of thrombosis. An overview

The coagulation response is a complex interaction involving the vascular surface, blood platelets, and the plasma coagulation factors. These reactions are integrated to give rise to a locally efficient generation of both platelet aggregates and the enzymatic process associated with fibrin formation. Following mechanical, chemical, or biological "damage" to the vascular endothelial surface, coagulation is initiated by a composite of cellular adhesive reactions certainly involving the platelet and potentially also involving other inflammatory cells. The blood coagulation mechanism can be presented as a collection of zymogen-to-enzyme transformations, with each proteases participating with a cofactor protein on a "surface" that gives rise to the competent blood clotting complex. These complexes catalyze the generation of additional enzymes required for succeeding reaction complexes. It is likely that the coagulation reaction system is continuously "on," producing products at some low "idling" rate, with the products of the various reactions being neutralized by the collection of protease inhibitors and cofactor-neutralizing reactions that regulate the blood clotting process. These latter systems include, as principal components, the antithrombin III-heparin anticoagulant and the activated protein C pathway that disables cofactor proteins. Small changes in the concentrations of modulators can cause large effects in response to relatively small inputs. The coagulation process may be regarded as being at an incipient stage, separated from visually observable coagulation by a narrow threshold, which, once crossed, gives rise to the generation of fibrin and other products associated with alpha-thrombin generation.(ABSTRACT TRUNCATED AT 250 WORDS)