Review article
Role of high shear rate in thrombosis

https://doi.org/10.1016/j.jvs.2014.12.050Get rights and content
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Acute arterial occlusions occur in high shear rate hemodynamic conditions. Arterial thrombi are platelet-rich when examined histologically compared with red blood cells in venous thrombi. Prior studies of platelet biology were not capable of accounting for the rapid kinetics and bond strengths necessary to produce occlusive thrombus under these conditions where the stasis condition of the Virchow triad is so noticeably absent. Recent experiments elucidate the unique pathway and kinetics of platelet aggregation that produce arterial occlusion. Large thrombi form from local release and conformational changes in von Willebrand factor under very high shear rates. The effect of high shear hemodynamics on thrombus growth has profound implications for the understanding of all acute thrombotic cardiovascular events as well as for vascular reconstructive techniques and vascular device design, testing, and clinical performance.

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Sources of funding were the American Heart Association Predoctoral Fellowship (14PRE1808005), Lawrence P. Huang Chair Funds, John and Linda Brock Funds, Center for Pediatric Innovation, and the National Defense Science and Engineering Graduate Fellowship (32 CFR 168a).

Author conflict of interest: D.N.K.: Consultant for Endologix, Aptus EndoSystems, Medtronic, and Cook. D.H.D.: Chief Medical Officer for Endologix and consultant for Aptus EndoSystems, Intact Vascular, BioConnect, and ROX Medical.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.