Getting smart with coagulation

Emmanuel J Favaloro, Leonardo Pasalic, Giuseppe Lippi

Research output: Contribution to journalArticlepeer-review


“Coagulation” is a word often used in this journal. One dictionary definition identifies coagulation as “the action or process of a liquid, especially blood, changing to a solid or semi‐solid state.” Coagulation is an essential element of hemostasis and fundamentally reflects the activation of secondary hemostasis, with thrombin generation eventually triggering the conversion of the major hemostasis protein fibrinogen (soluble) to fibrin (insoluble), which in vivo is ultimately effective to stabilize the primary (prevalently platelet) clot after activation of primary hemostasis. Inadequate coagulation can arise in a variety of disorders. 1.In vitro laboratory tests of coagulation tend to separate some components of primary hemostasis, viz the platelets, and assess secondary hemostasis in a cell‐free system. The main routine coagulation assays are the activated partial thromboplastin time (APTT) and the prothrombin time (PT). 2., 3.In a laboratory setting, these tests are performed using platelet poor plasma, are sensitive to presence or absence of various drugs and exogenous inhibitors of coagulation factors, and are thus used to screen for the presence of hemostasis dysfunction, or to monitor various types of anticoagulant therapy. For example, APTT is often used for monitoring heparin therapy, 2., 4.and PT, as typically converted to an INR (international normalized ratio), used for monitoring vitamin K antagonist (VKA) therapy (e.g., warfarin, acenocumarol). 3.In particular, patients under VKA therapy require regular monitoring of INR to ensure this remains within a recommended therapeutic range (e.g., 2.0–3.0 for most indications); INR values below and above such ranges increase the risk of adverse events (e.g., thrombotic recurrence or bleeding, respectively).
Original languageEnglish
Pages (from-to)1519-1522
Number of pages4
JournalJournal of Thrombosis and Haemostasis
Issue number7
Early online date16 Mar 2022
Publication statusPublished - Jul 2022


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