ABSTRACT
Much of our understanding of the pathogenesis of thrombosis has long been based on
observations made on large blood vessels. Nevertheless, there has been a recent shift
in our attention to the microvasculature and to how microcirculatory occlusion affects
function of various organs in diseases. This article provides an overview of microthrombosis
in small blood vessels, with discussion of the progressive stages of its development.
The initial event is triggered by a variety of diseases, followed by a second phase
when multiple contributory factors amplify the process with the final phase of microvascular
occlusion and microvascular thrombosis. The outcome is either recovery or injury to
the affected organ. If the process is generalized, it is often associated with catastrophic
or fatal outcomes. Our current knowledge of the major role of contributory factors
leads to a new paradigm. A therapeutic approach limited to a single target of the
underlying pathogenic factor, such as the use of anticoagulants, is insufficient and
too often unsuccessful. Simultaneous management of all the contributory factors should
therefore be considered.
KEYWORDS
Thrombosis - disseminated intravascular coagulation - inflammation - hypercoagulable
state - sepsis
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Marjorie C. Barnett Professor of Hematology-Oncology, Professor of Medicine, Northwestern
University Feinberg School of Medicine
710 Fairbanks Court, Olson Pavilion, Room 8258, Chicago, IL 60611
Email: h-kwaan@northwestern.edu
