Arterial thrombosis for the interventional cardiologist: From adhesion molecules and coagulation factors to clinical therapeutics

Arterial thrombosis is the result of a complex and well-orchestrated set of events where interactions between platelets and leukocytes are intertwined with enzymatic reactions of the coagulation system. Here, we present a contemporary panorama of arterial thrombosis and provide a framework the interventionalist can use to understand the current antithrombotic pharmacotherapies and recognize the role of therapies that have yet to be developed. We analyze thrombosis in the context of plaque rupture and vascular injury and describe the interactions between platelets and the subendothelium. We then discuss platelet-leukocyte interactions, emphasizing the inflammatory nature of thrombosis and how this relates to vessel restenosis following angioplasty. The different reactions of the coagulation system are described not from an isolated perspective, but are integrated into the sequence of cell-cell interactions that parallel them. Finally, we describe the mechanisms that terminate the thrombotic response.