Thrombosis vs. Hemostasis: Balancing the competing risks of bleeding and clotting

Hemostasis is the physiological response to vessel injury that requires activation of the coagulation cascade. This is a highly complex and ‘self-regulating’ series of enzymatic reactions of zymogens that ultimately culminates in the formation of a stable clot. Unfortunately, an exuberant response can lead to pathological clotting or thrombosis. Other conditions that lead to thrombosis include venous stasis and hypercoagulable states that mobilize other physiological pathways and augment coagulation activation. To reduce thrombosis formation or extension, anticoagulant therapy is used to inhibit coagulation, and thereby necessarily renders the patient at risk for excessive bleeding when tissues and vessels are injured. Consequently, the ‘holy grail’ of finding the ideal anticoagulant has been focused on dissociating these competing risks of bleeding and clotting.

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