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Revised Coagulation Cascade: In Vivo Vessel injury

Cross Linked Fibrin

Insoluble monomer cross-linked fibrin

Figure 15.5 In vivo coagulation cascade.

Insoluble monomer cross-linked fibrin

Laboratory Model of Coagulation

Laboratory testing looks at the in vitro effect of the coagulation process which is measured by the prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrin degradation products (FDPs), and D-dimer. This section will focus on PT and a PTT, while Chapter 20 will concentrate on the other routine tests mentioned. While the coagulation cascade does not reflect what goes on in vivo, it provides a model in which the laboratory relates to for testing. However, the coagulation cascade reflects the mechanisms that the laboratory uses for results. The screening tests provide a tremendous amount of information to the physician. They can be performed both quickly and accurately (Fig. 15.6).

Extrinsic Pathway

The extrinsic pathway is initiated by the release of tissue thromboplastin that has been expressed after damage to aPTT (Heparin therapy) INTRINSIC SYSTEM Contact activation pathway

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