VTE IMAGE LIBRARY
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Coagulation Cascade
Coagulation cascade overview
Cascade overview
Cascade Overview
Cascade Overview
An overview of the coagulation cascade, showing the initiation, propagation, and clot formation phases.
Clotting initiated in coagulation cascade
Initiation
Initiation
Initiation
Clotting is initiated by the activation of Factor VII by membrane-bound tissue factor. This leads to activation of Factor X, which then produces small amounts of thrombin.
Propagation
Propagation
Activated Factor X, functioning as part of the prothrombinase complex on the surface of activated platelets, converts large amounts of prothrombin to thrombin, in the "thrombin burst."
Clot formation during the coagulation cascade
Clot formation
Clot Formation
Clot Formation
Thrombin converts fibrinogen to fibrin monomers which polymerize to form fibrin strands, Factor XIII, activated by fibrin, cross-links the fibrin strands to create a fibrin scaffold for a stable clot.
Natural inhibitors of coagulation
Natural inhibitors
Natural Inhibitors
Natural Inhibitors
The natural inhibitors of coagulation include tissue factor pathway inhibitor (TFPI), activated protein C (APC), and antithrombin (AT).
Fibrinolysis and the coagulation cascade
Fibrinolysis
Fibrinolysis
Fibrinolysis
Plasminogen activators from injured endothelium convert plasminogen to plasmin which in turn breaks up the fibrin strands into smaller fragments, including d-dimer.
Hemostasis
A coagulation schematic
Coagulation schematic
Coagulation schematic
Coagulation schematic
The process of coagulation depends on a complex interplay of enzymatic and cellular activity, culminating in the formation of a stable vascular "plug". The subsequent process of clot dissolution that occurs during the healing phase is known as "fibrinolysis".
Red thrombi form in veins
Red thrombi
Red thrombi
Red thrombi
Red blood cells predominate in red thrombi, which form in veins. In contrast, platelets are the main cellular components of white thrombi, which tend to form in the arterial system.
A burst of thrombin formation
Thrombin formation
Thrombin formation
Thrombin formation
A burst of thrombin formation (represented by blue spheres) triggered by activated Factor X is a pivotal step in the coagulation cascade.
A burst of thrombin formation
Role of venous valves
Role of venous valves
Role of venous valves
Blood flow in the major veins of the lower extremity depends, in part, on the pumping action produced by leg muscle contractions. Retrograde flow is prevented by venous valves.
Rudolph Virchow's Triad
Virchow's Triad
Virchow's Triad
Virchow's Triad
The pathologist Rudolph Virchow was the first to describe the three main factors that predispose to thrombosis.
The heart and VTE
The heart
The heart
The heart
The right side of the heart delivers deoxygenated blood to the lungs; the left side pumps oxygenated blood to the systemic circulation.
A thrombus can block major veins
Major veins
Major veins
Major veins
A thrombus can block the flow of blood through a vein or artery and can detach from the vessel wall to become a life-threatening embolus when it lodges in the lungs or other vital organs.
Pulmonary Embolus
Fragments of thrombi form pulmonary emoli
Embolus formation
Embolus formation
Embolus formations
Fragments of thrombi can break free to form potentially life-threatening pulmonary emboli.
Lung with obstructed pulmonary arteries
Pulmonary embolus
Pulmonary embolus
Pulmonary embolus
Whole lung in which pulmonary arteries are obstructed by fresh (red) thrombus (circles).
The pathway of a pulmonary embolism
Pulmonary embolism
Pulmonary embolism
Pulmonary embolism
The pathway of a pulmonary embolism (PE) from the lower half of the body: inferior vena cava, to right atrium, to right ventricle, to the pulmonary artery. This eventually obstructs blood flow to the lung. Patients with deep vein thrombosis (DVT) are at risk of PE, a life-threatening event.
Pulmonary embolus with hemorrhage
Pulmonary embolus with hemorrhage
Pulmonary embolus with haemorrhage
Pulmonary embolus with haemorrhage
Section of pulmonary parenchyma with middle right (round) blood vessel containing embolus. The surrounding lung parenchyma has undergone haemorrhagic infarction.
Venous Thrombosis
DVT is the most common type of VTE
Major veins of the lower extremity
Major veins of the lower extremity
Major veins of the lower extremity
The most common type of VTE is deep vein thrombosis (DVT), which occurs in veins deep within the muscles of the leg and pelvis.
Common femoral vein, cross-sectional view
Common femoral vein
Common femoral vein
Common femoral vein
Cross-sectional view of the common femoral vein showing a significant degree of thrombotic occlusion of the vessel lumen. This imaging technique renders the thrombus as black, while areas of blood flow are colorised.
Partial venous occlusion can lead to other symptoms
Partial venous occlusion
Partial venous occlusion
Partial venous occlusion
Thrombi partially obstruct venous return, which can lead to symptoms such as venous distension and lower extremity oedema.
Popliteal vein
Popliteal vein
Cross-sectional view of the politeal vein showing partial obstruction of the vessel lumen. This imaging technique renders the thrombus (no flow) as black, while areas of blood flow are colorised.
Longitudinal view of common femoral vein clot
Common femoral vein clot
Common femoral vein clot
Common femoral vein clot
Thrombus (dark area) occluding more than half the diameter of the common femoral artery (as seen in this longitudinal view). This imaging technique renders the thrombus as black, while areas of blood flow are colorised.
Venous lumen occluded by thrombus in posterior tibial vein
Posterior tibial vein
Posterior tibial vein
Posterior tibial vein
This longitudinal view reveals that more than half of the venous lumen is occluded by thrombus (black area). Areas of blood flow within the vein appear red. This imaging technique renders a thrombus as black, while areas of blood flow are colorised.
Venous thrombi forming in the cusps of veins
Venous thrombus formation
Venous thrombus formation
Venous thrombus formation
Venous thrombi tend to form in the cusps of veins.
Vein with thrombus in lumen
Deep vein thrombosis
Deep vein thrombosis
Deep vein thrombosis
Vein with thrombus in lumen.
