The body’s endogenous anticoagulants, such as protein C and protein S and Antithrombin-III prevent the formation of thrombosis through a complex regulatory mechanism that maintains homeostasis. We tested our shear-dependent model against their results, and can achieve similar trends and threshold shear rates at which occlusion occurs. The snapshots of the developed thrombi are given in Fig 3b–3d for several flow rates, where red particles represent activated platelets that can adhere to the site of injury and blue particles are resting platelets. Experimental results of Westein et al. Then the goal becomes reducing your chances of deep vein thrombosis happening again. from a microfluidic device with different degrees of stenosis. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Therefore, adhesive forces are stronger representing slow, but strong bonds formed by GPIIb-IIIa. [14] allowed model calibration at medium to high shear rates where the maximum wall shear rate at the apex reaches 8,000 s−1. Virchow’s triad describes the pathogenesis of thrombus formation. This may be followed by irreversible platelet activation and the release of ADP, whereas thrombin production is excluded from these experiments. Additional details will be discussed in section Results. Hemostasis involves three basic steps: vascular spasm, the formation of a platelet plug, and coagulation, in which clotting factors promote the formation of a fibrin clot. [15] observed that platelet aggregation was predominately in the post-stenosis region and proposed that the aggregation of platelets was resulted from platelet tethering. Now, with the use of thrombolytics and anticoagulants, the incidence of thrombi has diminished but not to a great extent. When the entire coagulation process works properly, blood holds firmly together at the site of an injury and bleeding stops. Transoesophageal echocardiography (TEE) is another, relatively noninvasive option and a good tool for diagnosis. (c) Exponential growth rates derived from simulations for three different conditions: platelet concentration taken as 500,000mm−3 (−△−); increased size of injury to 60μm (−▽−); and the inclusion of shear-induced platelet’s drift according to Eq (6) (−○−). Competing interests: The authors have declared that no competing interests exist. Blue particles are plotted smaller for clarity. We introduce an Eulerian-Lagrangian model where hemodynamics is solved on a fixed Eulerian grid, while platelets are tracked using a Lagrangian framework. The profiles show an almost independent thrombin burst and the subsequent fibrin generation at the center and downstream of the injury, whereas a delayed thrombin burst occurs at t ≈ 12 s proximal to the injury, where platelet aggregation is more pronounced. This signifies the effect of blood flow on the transport of coagulation reactants away from the site of injury before they can initiate the cascade. In the heart, macrothrombi can develop as a result of blood stasis in the ventricles or atria due to underlying valvular heart disease, cardiomyopathies or arrhythmias such as atrial fibrillation predisposing to ischemic emboli and CVA. He Li, * E-mail: george_karniadakis@brown.edu (GEK); alireza_yazdani@brown.edu (AY), Affiliation Thromb. You’ll also have a physical exam so that your doctor can check for areas of swelling, tenderness or discoloration on your skin. 2018 Aug 19;:1358863X18788952, Ashorobi D, Fernandez R. Thrombosis. In: StatPearls [Internet]. An embolus is often a small piece of a blood clot that breaks off (thromboembolus). Simulation results (−□−) are based on the activation delay time τact = 6 ± 3ms, and the error bars are computed based on 5 simulations with the same τact; experimental data (−○−) are extracted from Westein et al. When two activated platelets interact with each other, a repulsive force results when r < d and an attractive force when r > d as shown by the red line segment in Fig 1. Endothelial wall damage is caused by different factors, which can include direct disruption of the vessel via catheter placement, trauma, or surgery. Funding: This work was supported by National Institute of Health Grant No. The initial adhesion of platelets on the thrombogenic area can be attributed to a variety of platelet membrane receptor-ligand interactions, such as glycoprotein Ib(GPIb)-V-IX with immobilized von Willebrand Factor (vWF), GPIIb-IIIa (αIIbβ3) with vWF, GPVI with collagen, α2β1 with collagen, αIIbβ3 with fibrinogen, and so on, depending on the nature of the lesion [4] and the local shear rate of blood flow [5–7]. Abnormal laminar flow induced by turbulence in arteries propagates the process. The Morse potential possesses a softer repulsive-core, however, which is much more stable when simulating platelet aggregation. [18], which has the advantage of including both TF and contact pathways in plasma. The reported distributions are obtained for platelet-sized latex beads suspended in whole blood flowing in tubes with ≈ 200 μm diameter at 40% hematocrit, where the average wall shear rate is ≈ 500 s−1. 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