The hemodynamic forces acting on thrombi, from incipient attachment of single cells to maturity and embolization

We consider the steady fluid forces acting on a thrombus from the time of first contact of a single cell with a natural or artificial surface, through the attachment process and growth to embolization. For a hemi-spherical or cylindrical attached cell of height less than 1/100-1/20th of the channel width, shear and tensile stresses are solely dependent on viscosity and on the ratio of average fluid velocity to channel width vt/Dt (shear rate). Large values of this ratio reduce adhesion and increase embolization. The average shear stress on such cells is approximately 1-10 Pa (10-100 dyn cm2), the average tensile stress about three times higher. For other shapes and larger protrusions, stress varies with protrusion height as well. Maturing thrombi composed of cell aggregates embedded in a fibrin mesh do not appear to allow significant fluid flow through their porous structure. The interior forces are then due solely to hydrostatic pressure and initially vary directly with vt/Dt and inversely with thrombus height Hp, thus favouring embolization at an early stage and in arterial systems. Rough surfaces are identified as causing an increase in dwell-time and possibly immobilizing an unattached cell due to 'negative lift'.