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Vascular endothelial function and fundamental mechanisms of fibrinolysis (thrombolysis)

Author
Richard C Becker, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Thrombolysis, defined as the dissolution of thrombus or, more specifically, the breakdown of fibrin (fibrinolysis), is a critical component of vascular homeostasis. If not for an intact fibrinolytic system, even the smallest thrombus required to stem blood loss following minor vessel wall injury would progress rapidly and potentially compromise tissue perfusing blood flow. Furthermore, intravascular fibrinolysis represents a vital defense mechanism, preventing "hemostasis in the wrong place" that could, under pathologic conditions, occur in the coronary arterial bed or cerebral vasculature. (See "Fibrinolytic markers and cardiovascular risk".)

An understanding of fibrinolysis has paved the way for the development of fibrinolytic (thrombolytic) agents that can be used therapeutically for a variety of thrombotic disorders including myocardial infarction, ischemic stroke, and acute pulmonary embolism. At the present time, fibrinolytic agents are used most often in the early treatment of acute myocardial infarction. (See "Fibrinolysis for acute ST elevation myocardial infarction: Initiation of therapy".)

The fundamental biology and physiology of the vascular endothelium and the mechanisms of thrombosis are reviewed here. This will be followed by a discussion of the mechanisms of and the factors influencing thrombolysis.

VASCULAR ENDOTHELIUM

The vascular endothelium is intricately related to normal vessel responsiveness that includes dilation and constriction as needed, and resistance to non-hemostatic blood clotting also known as thromboresistance. It is a multifunctional organ system composed of metabolically active and physiologically responsive component cells that meticulously regulate blood flow, according to metabolic conditions.

Anatomic considerations — Vascular endothelial cells form a single layer of simple squamous lining cells. The cells themselves are polygonal in shape, varying between 10 and 50 µm in diameter, and elongated in the long axis, orienting the cellular longitudinal dimension in the direction of blood flow. The endothelial cell has three surfaces:

                                

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Literature review current through: Nov 2016. | This topic last updated: Tue Sep 08 00:00:00 GMT+00:00 2015.
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