The Coagulation Cascade

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The coagulation cascade is a key component of hemostasis and is the main contributor to thrombosis. It consists basically in a series of reactions that convert zymogens (inactive enzyme precursors) into active enzymes whose final step is thrombin production. Subsequently, thrombin turns fibrinogen (a soluble plasma protein) into fibrin (an insoluble plasma protein).

Each reaction of the cascade results from an assembly of a complex in which an enzyme (an activated coagulation factor), a substrate (a coagulation factor in the form of a proenzyme) and a cofactor (a reaction accelerator) intervene. Assembly of these components occurs on a phospholipid complex, and they remain bound to
each other owing to the action of calcium ions.

Thus, coagulation occurs in sites where this binding is possible (endothelium, activated platelet surface). Coagulation pathway is divided into an extrinsic pathway (activated by tissue factor, which is a cell lipoprotein that is fully functional in the presence of tissue damage), and an intrinsic pathway, both of which converge at the activation of factor X. Notwithstanding that, both pathways are interrelated. Once the cascade process starts, it becomes restricted to the site of the lesion in order to prevent it from spreading to the vascular network.

La cascada de la coagulación constituye un componente fundamental de la hemostasia y es el que más contribuye a la trombosis. Consiste básicamente en una serie de pasos que convierten a proenzimas inactivas en enzimas activadas cuyo paso final es la producción de trombina. A continuación, la trombina convierte al fibrinógeno (proteína plasmática soluble) en fibrina (proteína plasmática insoluble). Cada una de las reacciones de la cascada es consecuencia de un ensamblaje de un complejo en el que intervienen una enzima (factor de la coagulación activado), un sustrato (factor de la coagulación en forma de proenzima) y un cofactor (acelerador de la reacción).

El ensamblaje de estos componentes se produce sobre un complejo de fosfolípidos y se mantienen juntos debido a iones de calcio. Por esta causa, la coagulación se produce en los lugares donde es posible este ensamblaje (endotelio, superficie de las plaquetas activadas). La vía de la coagulación se divide en vía extrínseca (activada por el factor tisular, lipoproteína celular que queda al descubierto cuando hay una lesión tisular) y vía intrínseca, ambas confluyen en la activación del factor X. No obstante, ambas vías están interrelacionadas. Una vez que se inicia el proceso de la cascada, el mismo queda restringido al sitio de la lesión para evitar que se propague a toda la red vascular.

Xarelto generic name: rivaroxaban class: factor Xa inhibitors
Pradaxa generic name: dabigatran class: thrombin inhibitors
Lovenox generic name: enoxaparin class: heparins
Arixtra generic name: fondaparinux class: factor Xa inhibitors
Innohep generic name: tinzaparin class: heparins
Heparin Sodium generic name: heparin class: heparins
Streptase generic name: streptokinase class: thrombolytics
Normiflo generic name: ardeparin class: heparins
Abbokinase generic name: urokinase class: thrombolytics
Kinlytic generic name: urokinase class: thrombolytics

Disclaimer: This information has been designed for professional purposes only. You should not rely on this information as a substitute for personal medical attention, diagnosis or hands on treatment. You should always consult a health provider as he is the only one who is capable of medicating and helping patients find a solution to their disease.