SECONDARY HEMOSTASIS

HEMOSTASIS Hemo = blood

Stasis = to stop from flowing

 Keeps the blood in a fluid

state to keep circulating
and temporarily impedes
its flow when there is a
bleeding by forming a
clot,
to the site of injury and

after the injured vessel is

healed.
CLOT
COAGULA
BB CLOT
FORMATION
TION OO DIGESTION
DD
YY

THROMBOSIS BLEEDING
KEY PLAYERS:

1. Blood Vessels
2. Platelets
3. Coagulation
Factors
and Regulatory
Proteins
HEMOSTASIS
KEY PLAYERS:

1. Blood Vessels
2. Platelets
3. Coagulation
Factors
and Regulatory
Proteins
Blood Vessels
 Anticoagulant Properties

Blood Vessels Procoagulant Properties

(Vascular Intima)
Fibrinolytic Properties
 Anticoagulant Properties

Blood Vessels Procoagulant Properties

(Vascular Intima)
Fibrinolytic Properties
 Anticoagulant Properties

Blood Vessels Procoagulant Properties

(Vascular Intima)
Fibrinolytic Properties

✓Secretion of:
✩Tissue Plasminogen
Activator
✩Plasminogen activator
inhibitor-1
COAGULATION
SYSTEM
COMPONENTS
Serine Proteases
 Procoagulant Group
FV HMWK Phospholipid vWF

Tissue
FVIII Fibrinogen Calcium
Factor
Cofactors
Coagulation Complexes
CLASSIFICATION ACCORDING TO PROPERTIES
Prothrombin Group
Prothrombin Group
 HMWK

Pre-
Kallikrein

Activated by:
•Non-siliconized glass, kaolin, ellagic
FXII acid
•Stents, valves prosthesis, bacterial cell
membrane, collagen

Contact Factors
 V
I
VIII
XIII

Fibrinogen Group
 FVIII AND VON WILLEBRAND FACTOR

vWF
✓ Produced by Weibel-Pallade
bodies

✓ Participate during platelet

adhesion
✓ Can bind to collagen
FVIII
✓ can bind with platelets
✓ forms complex with and
(intrinsic tenase)
FIBRINOGEN AND FIBRIN FORMATION, FXIII
FIBRINOGEN AND FIBRIN FORMATION, FXIII
 Extrinsic
Intrinsic Pathway
Pathway
Pre-K, HMWK, XII, XI, IX,
VIII
TF, VII

Common Pathway

X, V, II, I, XIII
REGULATORY MECHANISM
To maintain a complex and delicate balance between thrombosis and abnormal bleeding

Tissue Factor Pathway Inhibitor

• Principal regulator of tissue factor
• Inhibits FXa and TF
REGULATORY MECHANISM
To maintain a complex and delicate balance between thrombosis and abnormal bleeding

Protein C System
• Activated Protein C : free Protein S complex
inactivates FV and FVIII
REGULATORY MECHANISM
To maintain a complex and delicate balance between thrombosis and abnormal bleeding

Antithrombin
• Neutralizes thrombin and IXa, Xa, XIa
REGULATORY MECHANISM
To maintain a complex and delicate balance between thrombosis and abnormal bleeding

Serine Protease Inhibitors

• ZPI
• Binds with protein Z + Xa + Ca + PL
• Inhibits IXa
• Protein C Inhibitor
• Non-specific
• Inhibits APC, thrombin, Xa, XIa and urokinase
• ɑ1 protease inhibitor, ɑ2 macroglobulin
FIBRINOLYSIS
FIBRINOLYSIS
 Balance between fibrin
deposition and lysis

 Helps keep the lumen of

injured blood vessels open

 Maintains and remolds

hemostatic seal during
repair of an injured vessel
Activation by:
 Tissue Plasminogen Activator
(tPA)

 Urokinase Plasminogen
Activator (uPA)
✓ Zymogen → Plasmin
✓ Have kringles
✓ free plasmin can potentially
hydrolyze:
✓ Fibrinogen
✓ FV
✓ FVIII
✓ Fibronectin
✓ Zymogen → Plasmin
✓ Have kringles
✓ free plasmin can potentially
hydrolyze:
✓ Fibrinogen
✓ FV
✓ FVIII
✓ Fibronectin
CONTROLS OF FIBRINOLYSIS

Plasminogen Activator Inhibitor-1 (PAI-1)

• Principal inhibitor of plasminogen activation
• Inactivates tPA and uPA

ɑ2-antiplasmin
• Primary inhibitor of free plasmin
• It is bound to fibrin clot by FXIIIa
CONTROLS OF FIBRINOLYSIS

Thrombin Activatable Fibrinolysis Inhibitor

(TAFI)
• Activated by thrombin-thrombomodulin complex
• Anti-fibrinolytic enzyme
• Hydrolyzes the C-terminus lysine residues to prevent
the binding of tPA and plasminogen to the fibrin clot
SECONDARY HEMOSTASIS