The convergent model of coagulation

May 30, 2024Journal of thrombosis and haemostasis : JTH

The combined process of blood clotting

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Abstract

The proposed model of coagulation integrates inflammation and immune response as a unified reaction to vascular injury.

Coagulation and innate immunity interact through a process known as immunothrombosis.
Current concepts of coagulation are insufficient to explain the complex interplay observed in various medical conditions.
Damage-associated molecular patterns released during injury play a crucial role in both promoting clot formation and guiding the healing process.
The convergent model of coagulation may lead to new diagnostics and treatments for challenges highlighted by recent health crises.

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It is increasingly apparent that the pathologic interplay between coagulation and innate immunity, ie, immunothrombosis, forms the common basis of many challenges across the boundaries of specialized medicine and cannot be fully explained by the conventional concepts of cascade and cell-based coagulation. To improve our understanding of coagulation, we propose a model of coagulation that converges with inflammation and innate immune activation as a unified response toward vascular injury. Evolutionarily integral to the convergent response are damage-associated molecular patterns, which are released as a consequence of injury. Damage-associated molecular patterns facilitate diverse interactions within and between systems, not only to complement and reinforce cell-based clot formation but also to steer the response toward clot resolution and wound healing. By extending coagulation beyond its current boundaries, the convergent model aims to deliver novel diagnostics and therapeutics for contemporary and unexpected challenges across medicine, as exposed by COVID-19 and vaccine-induced immune thrombotic thrombocytopenia.

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Abstract

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