Chapter 52 - Hemostasis and Thrombosis

Abstract

Hemostasis, as a highly regulated teleological process, and blood coagulation are cell surface, biochemical events designed not only to stem the loss of blood following vascular injury through fibrin formation, but also to provide the necessary cellular and protein constituents for vascular growth and repair. Conceptually, blood coagulation represents a complex yet well-coordinated series of events which involve tissue factor-bearing cells and platelets. The initiation and propagation phases of coagulation are catalyzed by thrombin in small (nM) and large concentrations, respectively. The heritability of blood coagulation is well known and can manifest clinically as either a predisposition to bleeding (impaired hemostasis) or clotting (thrombophilia). Our chapter frames the fundamental constructs of coagulation in practical terms, including genetic determinants, environmental influences, impact of race, culture and ethnicity, the use of genetic testing in patient and population screening, and guidance for management in routine care.