Arterial and venous thrombosis. Is the Virchow’s triad always valid?

Despite the success of conservative and surgical treatment of vascular diseases, the prevention of arterial and venous thrombosis remains extremely actual. For more than a hundred years, the so-called «Virchow’s triad» has been used to explain the mechanism of thrombosis: 1–slowing of blood flow; 2–hypercoagulation; 3 – damage to the vascular wall. However, the combination of these factors is fully applicable only for venous thrombosis and limited for arterial thrombosis. The generally accepted strategy for the prevention of venous thrombosis is the use of anticoagulants, while for arterial thrombosis – antiaggregants. In recent years the mechanisms of blood clot formation at high blood flow rates in the areas of arterial stenosis, as well as the role of platelets and von Willebrand factor in this process, were investigated. In the presented review, the details of the mechanisms of thrombosis in the arteries are analyzed and the concept of «arterial triad» is introduced. Arterial triad includes: 1 – arterial stenosis (increase in shear rate); 2 – platelets (their activation and interaction with von Willebrand factor); 3 – damage of the vascular wall. The arterial triad describes the mechanisms of thrombosis in the presence of artery stenosis (usually due to atherosclerosis). Understanding similarities and differences between Virchow’s and arterial triads, will allow us to estimate the risk factors in patients with cardiovascular pathology and develop optimal methods of their prevention.