Thrombosis

Mamata Tiwari, MBBS,MD

 Learning objectives

• Define and classify thrombosis

• Etiopathogenesis of thrombosis
• Morphology of thrombosis
• Fate of thrombosis
 Definition

• Formation of abnormal blood clot

within the intact circulatory system
 Classification
• According to site
– Arterial, venous, cardiac
• According to color 
– Red, pale & mixed
• According to presence or absence of
bacteria 
– Septic & bland
• According to lumen obstruction
– Occlusive & mural
 Etiology
• Virchow triad
 Endothelial injury
• Severe endothelial injury  expose
vWF and tissue factor
• Inflammation and other noxious
stimuli shift the pattern of gene
expression in endothelium to
prothrombotic
 Alternations in Normal Blood
Flow
• Turbulence & Stasis promote
procoagulant activity
• Disrupt laminar flow and bring
platelets into contact with the
endothelium
• Prevent washout and dilution of
activated clotting factors by fresh
flowing blood and the inflow of
clotting factor inhibitors
 Hypercoagulability
• Disorder of the blood that
predisposes to thrombosis
• Can be primary (genetic) and
secondary (acquired)
 Causes of hypercoagulability
• Primary (Genetic)
• Common causes 
• Factor V mutation
• Prothrombin mutation
• Increased levels of factors VIII, IX,
XI or fibrinogen
 Causes cont..

• Rare 
• Antithrombin III deficiency
• Protein C deficiency
• Protein S deficiency
• Very Rare
• Fibrinolysis defects
• Homozygous homocystinuria
 Causes cont..

• Secondary (Acquired)
• Prolonged immobilization
• Myocardial infarction
• Atrial fibrillation
• Tissue injury (surgery, fracture,
burn)
• Cancer
• Prosthetic cardiac valves
 Morphology

• Develop anywhere in cardiovascular

system
• Vary in size and shape
• Arterial thrombi  begin at sites of
turbulence or endothelial injury
• Venous thrombi  occur at sites of
stasis
 Morphology cont..

• Focally attached to underlying

vascular surface
• Arterial thrombi  grow retrograde
• Venous thrombi  in the direction of
blood flow
 Morphology cont..

• Grossly and microscopically show

laminations called lines of Zahn 
pale platelet and fibrin deposits
alternating with darker red cell–rich
layers
 Morphology cont..

• Thrombi occurring in heart chambers

or in the aortic lumen mural
thrombi
• Thrombi on heart valves are called
vegetations
 Common sites

• Arterial thrombi  coronary,

cerebral, and femoral arteries
• Venous thrombi  veins of lower
extremities  (90% of cases)
Thrombus vs postmortem clot

• Post mortem clots  form after

death are gelatinous and have dark
red dependent portion and yellow
chicken fat upper portion
• Not attached to underlying vessel
wall
 Fate of the Thrombus

• Propagation
• Embolization
• Dissolution
• Organization and
recanalization
Thank you