The Coagulation Cascade

Injury to blood vessel Contact activation Platelet activation von Willebrand factor adheres platelets to damaged cells Platelet aggregation and formation of loose platelet plug
HMWK, PK, Ca2+

Tissue factor released by injured cells

HMWK, PK

XII XIIa

XI XIa Intrinsic System

Ca2+

IX IXa

VIIa VII
PL, Ca2+

VIII VIIIa

Va V

X Xa
Heparin activates Antithrombin which inhibits IIa, XIa, IXa, and Xa Takes place on the surface of activated platelets
PL, Ca2+

Thrombin + Thrombomodulin

Prothrombin (II) (IIa) Thrombin

Protien C Ca + Protein S, degrades Va and VIIIA

Extrinsic System Common Pathway

Tissue thromboplastin (III)

Thrombin accelerates process

(I) Fibrinogen Fibrin (Ia)

Fibrin monomers become polymers and weave through platelet plug

Fibrin stabilizing factor XIII XIIIa

Fibrinolytic System

Tissue-type plasminogen activator (tPA bound to fibrin)

Stable fibrin clot, fibrin strands crosslinked

Plasminogen Plasmin
Digests Fibrin HMWK = High Molecular Weight Kininogen PK = Prekallekrein PL = Phospholipids from activated platelets Ca2+ = Calcium

Clot breaks into soluble fragments Fibrin degradation products

2003 American Association for Clinical Chemistry Downloaded from Lab Tests Online (www.labtestsonline.org)

Coagulation Cascade 2/19/2004