The interplay between platelet activation and coagulation pathways drives fibrin clot formation, supporting the clinical benefit of combination therapy in secondary cardiovascular disease prevention.
. In the buildup of a platelet-fibrin thrombus, the extrinsic, tissue factor-driven coagulation pathway is predominant in early stages, while the intrinsic, factor XII pathway seems to promote at later time points. Already early generation of thrombin enforces platelet responses and stimulates intra-thrombus heterogeneity with patches of loosely aggregated, contracted, and phosphatidylserine-exposing platelets. Fibrin actively formed on the surface of activated platelets supports thrombus growth, but also captures thrombin. The fibrin distribution in a thrombus appears to rely on the local procoagulant trigger and the blood flow rate. Clinical studies support the importance of the platelet-coagulation interplay, by showing beneficial effects of combination therapy in the secondary prevention of cardiovascular disease.
Swieringa et al. (Sun,) conducted a review in Thrombus formation. The interplay between platelet activation and coagulation pathways drives fibrin clot formation, supporting the clinical benefit of combination therapy in secondary cardiovascular disease prevention.