What are the 3 anticoagulant mechanisms in the pathophysiology of deep venous thrombosis (DVT)?

Updated: Jul 05, 2017
  • Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Three naturally occurring anticoagulant mechanisms exist to prevent inadvertent activation of the clotting process. These include the heparin-antithrombin III (ATIII), protein C and thrombomodulin protein S, and the tissue factor inhibition pathways. When trauma occurs, or when surgery is performed, circulating ATIII is decreased. This has the effect of potentiating the coagulation process. Studies have demonstrated that levels of circulating ATIII is decreased more, and stay reduced longer, after total hip replacement (THR) than after general surgical cases (see the image below).

Deep venous thrombosis (DVT). This chart shows pos Deep venous thrombosis (DVT). This chart shows postoperative antithrombin III levels.

Furthermore, patients who have positive venograms postoperatively tend to be those in whom circulating levels of ATIII are diminished (see the image below).

Deep venous thrombosis (DVT). This chart depicts p Deep venous thrombosis (DVT). This chart depicts perioperative antithrombin III levels and DVT formation.

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