- Normal hemostasis involves a sequence of interrelated reactions that lead to platelet aggregation (primary hemostasis) and activation of coagulation factors (secondary hemostasis) to produce a durable vascular seal.
- Primary hemostasis consists of an immediate but temporary response to vessel injury, where platelets and von Willebrand factor (vWF) interact to form a primary hemostatic plug.
- Secondary hemostasis results in formation of a fibrin clot (Figure 20-1). Injury exposes extravascular tissue factor to blood, which initiates activation of factors VII and X and prothrombin. Subsequent activation of factors XI, VIII, and V leads to generation of thrombin, conversion of fibrinogen to fibrin, and formation of a durable clot.1
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