Thrombus Formation

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There are many types of blood contacting medical devices. For example, in the area of cardiovascular treatment there are heart valves, vascular grafts and stents and in cardiac rhythm management there are pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac monitors. Also, implantable catheters and ports are used for venous access and drug delivery in patients, with conditions such as cancer and systemic hypertension.

However, these devices are prone to failure, most notably due to thrombus formation. The pathological development of a thrombus presents considerable health hazards as it is not haemostasis (normal thrombus formation). A pathological thrombus is created when there is an interruption to the blood coagulation system equilibrium. This can block the flow of blood which causes numerous amounts of severe health conditions. If it separates from the wall of a vessel and embeds in the lungs, or other major organs, it can be a death-causing embolus.
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It was hypothesised by Rudolph Virchow that irregularities in three parts (Virchow’s triad) lead to the formation and spreading of thrombus. Nowadays it is achievable to measure some of the influences that increase the development of venous thromboembolism (VTE) and other cardiovascular syndromes. The Virchow’ triad suggested that the formation and proliferation of thrombus was caused by (i) blood flow, (ii) vessel wall and (iii) blood components. Irregularities in any of these three areas can lead to formation of thrombus.

Platelet aggregates and fibrin are components of thrombi that develop on medical devices that are in contact with blood. Therefore, it seems the most obvious solution to use anticoagulants and antiplatelet agents to inhibit or handle clotting. Therefore, it is crucial that haematologists comprehend the mechanisms behind clotting caused by medical devices in contact with blood and how to treat
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