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The Coagulation System and Blood Clot Stability

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Essentials of Blood Product Management in Anesthesia Practice

Abstract

Perioperative hemorrhage is one of the major challenges in the care of patients undergoing surgical and other invasive procedures. The etiologies can include technical difficulties and complications of surgery, and coagulation abnormalities. The coagulation cascade, a very dynamic process involving series of enzymatic reactions, is pivotal to a normal blood circulation and hemostasis. Hemostasis can be achieved by activation of intrinsic pathway or extrinsic pathway. It is also critical to maintain a delicate balance between the clot formation and the fibrinolysis. Hemostasis can be categorized as primary hemostasis (platelets adhere to the site of injury) and secondary hemostasis (coagulation activation leading to fibrin and clot formation). The normal coagulation process can include three phases: the initiation phase, the amplification phase and the propagation phase. The most important regulation mechanisms in coagulation are their multiple zymogens and cofactors all requiring activation prior to exerting their effects. The basic principle of clot stability is maintaining a balance between clot formation and fibrinolysis. This balance is regulated by numerous factors including molecular, metabolic, mechanical, and pharmacologic. And the processes of coagulation and fibrinolysis frequently occur simultaneously in many clinical scenarios. The many steps in coagulation and fibrinolysis can also be the targets for pharmacological interventions.

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Author information

Authors and Affiliations

  1. New York University Langone School of Medicine, Department of Anesthesiology, New York, NY, USA

    Nikita Nayyar

  2. Thomas Jefferson University Hospital, Department of Anesthesiology, Philadelphia, PA, USA

    Haig Mannasian

  3. Huangshi Central Hospital, Department of Anesthesiology, Huangshi, Hubei, China

    Longqiu Yang

  4. Department of Anesthesiology and Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA

    Henry Liu

Authors
  1. Nikita Nayyar
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  2. Haig Mannasian
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  3. Longqiu Yang
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  4. Henry Liu
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Editor information

Editors and Affiliations

  1. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Corey S. Scher

  2. Departments of Anesthesiology and Pharmacology Toxicology, and Neurosciences, Louisiana State University School of Medicine-Shreveport, Shreveport, LA, USA

    Alan David Kaye

  3. Department of Anesthesiology and Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA

    Henry Liu

  4. NYU Grossman School of Medicine, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, NY, USA

    Seth Perelman

  5. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Sarah Leavitt

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Nayyar, N., Mannasian, H., Yang, L., Liu, H. (2021). The Coagulation System and Blood Clot Stability. In: Scher, C.S., Kaye, A.D., Liu, H., Perelman, S., Leavitt, S. (eds) Essentials of Blood Product Management in Anesthesia Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-59295-0_4

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  • DOI: https://doi.org/10.1007/978-3-030-59295-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-59294-3

  • Online ISBN: 978-3-030-59295-0

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