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The current status of coagulation
1Department of Pediatrics/Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St Louis, MO, USA.
Annals of Medicine
|February 1, 1995
Summary
The traditional view of blood coagulation favored the intrinsic pathway. New evidence highlights the crucial role of tissue factor, revising our understanding of hemostasis.
Area of Science:
- Biochemistry
- Physiology
- Hematology
Background:
- The 1964 cascade/waterfall hypothesis organized hemostasis into intrinsic and extrinsic pathways.
- Historically, the intrinsic pathway was considered of primary physiological importance in coagulation.
- Clinical observations and experimental data challenge this long-held view.
Purpose of the Study:
- To re-evaluate the physiological significance of different coagulation pathways.
- To present evidence supporting a revised theory of blood coagulation.
- To emphasize the role of tissue factor in hemostasis.
Main Methods:
- Review of recent experimental evidence.
- Analysis of clinical data from patients with coagulation factor deficiencies.
- Consideration of newly discovered and characterized proteins involved in coagulation.
Main Results:
- Experimental data suggest a more prominent role for tissue factor in hemostasis.
- Clinical outcomes in factor-deficient patients support the significance of tissue factor.
- The rediscovery of tissue factor pathway inhibitor provides new insights.
Conclusions:
- A revised theory of coagulation is supported by current evidence.
- Tissue factor plays a more central role in hemostasis than previously recognized.
- New understanding of coagulation factors and inhibitors necessitates updated models.