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Overview of hemostasis

Lawrence LK Leung, MD
Section Editor
Pier Mannuccio Mannucci, MD
Deputy Editor
Jennifer S Tirnauer, MD


Hemostasis is the process of blood clot formation at the site of vessel injury. When a blood vessel wall is disrupted, the hemostatic response must be quick, localized, and carefully regulated. Abnormal bleeding or thrombosis (ie, nonphysiologic blood clotting not required for hemostatic regulation) may occur when specific elements of these processes are missing or dysfunctional.

The pathways of thrombin-stimulated fibrin clot formation and plasmin-induced clot lysis are linked and carefully regulated (figure 1 and figure 2 and figure 3) [1]. When they work in coordinated harmony, a clot is laid down initially to stop bleeding, followed by eventual clot lysis and tissue remodeling.

Abnormal bleeding can result from diminished thrombin generation (eg, due to factor VIII deficiency) or enhanced clot lysis (eg, due to alpha-2-antiplasmin deficiency). Conversely, excessive production of thrombin (eg, due to an inherited thrombophilia) can lead to thrombosis.

The elements responsible for normal hemostasis will be reviewed here. Approaches to the patient with abnormal bleeding or abnormal thrombosis are discussed separately. (See "Approach to the adult patient with a bleeding diathesis".)

The uses of platelet function testing and coagulation assays to diagnose hemostatic abnormalities are discussed separately. (See "Platelet function testing" and "Clinical use of coagulation tests".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 01, 2017.
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