The effect of Coumadin upon thrombus forming on foreign surfaces

Experience with the Stagnation Point Flow Experiment has revealed the earliest microscopic events surrounding thrombus inception and growth on foreign surfaces in a perfectly defined flow field. Using 40 and 80 X magnification, the effects of Coumadin upon these events was studied. These events include leukocyte adherence, fibrin deposition and platelet aggregation, deviation of flow streamlines around these aggregates, and subsequent downstream thrombus growth. Surface density of leukocytes was measured as a function of time and shear, and served as an index of the quantity of thrombus on the surface, which in turn, allowed direct comparisons of thrombus growth rate between experiments. Coumadin decreases the adhesive force between leukocytes or thrombi and the foreign surface. Emboli are more frequent with Coumadin, but are smaller. Thrombus inception is not altered. These results suggest that clinical benefit obtained from use of Coumadin derives from reduction in size of emboli.