Thromb Haemost 2013; 109(04): 569-579
DOI: 10.1160/TH12-10-0772
Position Paper
Schattauer GmbH

General mechanisms of coagulation and targets of anticoagulants (Section I)

Position Paper of the ESC Working Group on Thrombosis – Task Force on Anticoagulants in Heart Disease
Raffaele De Caterina*
1   Cardiovascular Division, Ospedale SS. Annunziata, G. d’Annunzio University, Chieti, Italy
,
Steen Husted*
2   Medical-Cardiological Department, Aarhus Sygehus, Aarhus, Denmark
,
Lars Wallentin*
3   Cardiology, Uppsala Clinical Research Centre and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
,
Felicita Andreotti**
4   Institute of Cardiology, Catholic University, Rome, Italy
,
Harald Arnesen**
5   Medical Department, Oslo University Hospital, Ulleval, Norway
,
Fedor Bachmann**
6   Department of Medicine, University of Lausanne, Lausanne, Switzerland
,
Colin Baigent**
7   Cardiovascular Science, Oxford University, Oxford, UK
,
Kurt Huber**
8   3rd Department of Medicine, Wilhelminenspital, Vienna, Austria
,
Jørgen Jespersen**
9   Unit for Thrombosis Research, University of Southern Denmark, Esbjerg, Denmark
,
Steen Dalby Kristensen**
10   Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
,
Gregory Y. H. Lip**
11   Haemostasis Thrombosis & Vascular Biology Unit, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
,
João Morais**
12   Cardiology, Leiria Hospital, Leiria, Portugal
,
Lars Hvilsted Rasmussen**
13   Department of Cardiology, Thrombosis Center Aalborg, Aarhus University Hospital, Aalborg, Denmark
,
Agneta Siegbahn**
14   Coagulation and Inflammation Science, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
,
Freek W. A. Verheugt**
15   Cardiology, Medical Centre, Radboud University Nijmegen, Nijmegen, Netherlands
,
Jeffrey I. Weitz**
16   Thrombosis & Atherosclerosis Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Received: 24 October 2012

Accepted after major revision: 25 February 2012

Publication Date:
22 November 2017 (online)

Summary

Contrary to previous models based on plasma, coagulation processes are currently believed to be mostly cell surface-based, including three overlapping phases: initiation, when tissue factor-expressing cells and microparticles are exposed to plasma; amplification, whereby small amounts of thrombin induce platelet activation and aggregation, and promote activation of factors (F)V, FVIII and FXI on platelet surfaces; and propagation, in which the Xase (tenase) and prothrombinase complexes are formed, producing a burst of thrombin and the cleavage of fibrinogen to fibrin. Thrombin exerts a number of additional biological actions, including platelet activation, amplification and self-inhibition of coagulation, clot stabilisation and anti-fibrinolysis, in processes occurring in the proximity of vessel injury, tightly regulated by a series of inhibitory mechanisms. ″Classical″ anticoagulants, including heparin and vitamin K antagonists, typically target multiple coagulation steps. A number of new anticoagulants, already developed or under development, target specific steps in the process, inhibiting a single coagulation factor or mimicking natural coagulation inhibitors.

* Coordinating Committee Member


** Task Force Member


 
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