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Physiology of Hemostasis

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Anticoagulation and Hemostasis in Neurosurgery

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Abstract

Hemostasis is a complex process mediated by enzymes, activators, inhibitors, platelets, neutrophils, and endothelial cells. Hemostasis helps close off damaged blood vessels, keep blood in a fluid state and dissolve blood clots following restoration of vascular integrity. Hemostasis is now also known to play an important role in wound healing and endothelial barrier protection and function. Further to the classic coagulation cascade or waterfall hypothesis and the cell-based model of coagulation, newer concepts have enabled better understanding of the blood coagulation process. Current molecular concepts have enabled a reappraisal of the intrinsic pathway of coagulation. Three physiological triggers of activation of the intrinsic pathway are now known to include collagen, the linear phosphate polymers, termed polyphosphates (PolyP), and neutrophil extracellular traps (NETs). NETs are also now known to have a role in fibrinolysis. DNA and histones are components of NETs that are released at the site of infection and intravascular thrombi. Large fibrin degradation products (FDP) bound to combinations of DNA and histones may help stabilize lysing clots. This understanding has led to a rationale for using DNAse as an adjunct to thrombolytic therapy.

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Authors and Affiliations

  1. Departments of Pathology and Pharmacology, Loyola University Health System, Maywood, IL, 60153, USA

    Jawed Fareed Ph.D.

  2. Departments of Pathology and Ophthalmology, Loyola University Health System, Maywood, IL, 60153, USA

    Omer Iqbal M.D.

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  1. Jawed Fareed Ph.D.
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Correspondence to Omer Iqbal M.D. .

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  1. Stritch School of Medicine, Loyola University, Maywood, Illinois, USA

    Christopher M. Loftus

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Fareed, J., Iqbal, O. (2016). Physiology of Hemostasis. In: Loftus, C. (eds) Anticoagulation and Hemostasis in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27327-3_1

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  • DOI: https://doi.org/10.1007/978-3-319-27327-3_1

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