The Coagulation Cascade and the Consensus Model of DVT

Abstract

The development of the blood coagulation ‘cascade’ concept after the Second World War, together with the increasing clinical use of anticoagulant and (later) thrombolytic treatment, is briefly reviewed and related to the origin of the consensus model. It is suggested that the consensus model arose from a research tradition that was essentially unrelated to thrombosis, and that its articulation entailed an effective, if unintended, suppression of Virchow’s pathophysiological viewpoint (as defined in the preface to this book) and also marginalised studies of the venous endothelium in relation to DVT. It is notable that Virchow’s explicit distinction between ‘clot’ and ‘thrombus’ was not preserved during this process; Virchow had hypothesised that thrombi are analogous to clots, but he knew the limitations of the analogy. The remainder of the chapter is devoted to a more or less detailed overview of the coagulation cascade as it is understood today. These details are included because no matter how the aetiology of DVT is considered, it is clear that the blood coagulation mechanism is involved at some point in the process. Some brief semantic points are raised for later discussion and development.