Homocysteine in vascular disease: an emerging clinical perspective

Traditionally, arterial and venous thrombo-embolism has been attributed to pathophysiological lesions in the vessel wall, or altered blood contents or flow through the lumen. Logically these fall into the category of a high-shear system, as opposed to the rather different circumstances in slowly moving columns of blood. The re-evaluation of this belief has been prompted by acknowledgement that there is currently a shift in emphasis. Recently we have recognised a common central factor in the internal dysfunction of the vessel that precedes and so initiates thrombocyte adhesion.