Clot structure predicts recurrent thrombosis

Abstract

In this issue of Blood, Cieslik et al have added assessments of clot structure as a potentially new and important way to predict recurrent deep vein thromboses (DVT) after withdrawal of anticoagulant therapy.1 Their work represents a departure from the standard approach to understanding blood coagulation, which is typically viewed through the lens of biochemistry as regulated pathways governed by specific clotting factor concentrations and activities. However, as Cieslik et al demonstrate, regulation of enzyme activity through proteolysis represents only 1 aspect of thrombosis and hemostasis. The final product of blood coagulation (ie, the clot) does not exist merely as a result of a ratio between activating and inhibiting enzymes; rather, it is a tangible, complex, and unique biological material.