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The Coagulation Cascade
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Intrinsic Pathway Initiation
Activated by damage inside the vascular system; Factor XII is activated to XIIa.
Extrinsic Pathway Initiation
Activated by external trauma leading to blood escaping the vascular system; Tissue factor (TF) binds with Factor VII, which is then activated to VIIa.
Common Pathway Initiation
Begins after intrinsic and extrinsic pathways converge; Factor X is activated to Xa.
Factor VIII
Acts as a cofactor for Factor IXa in the intrinsic pathway; aids in activating Factor X.
Factor IX
Activated to IXa in the intrinsic pathway; assists in converting Factor X to Xa.
Factor X
Activated to Xa in the common pathway; forms part of the prothrombinase complex which converts prothrombin to thrombin.
Factor VII
Activated to VIIa by Tissue Factor (TF) in the extrinsic pathway; helps activate Factor X.
Prothrombin Activation
Prothrombin (Factor II) is converted to thrombin (IIa) by the prothrombinase complex.
Thrombin
Converts fibrinogen to fibrin, activates platelets, and amplifies coagulation by feedback activation of factors V, VIII, and XI.
Fibrinogen to Fibrin Conversion
Thrombin cleaves fibrinogen to form fibrin, which then polymerizes and crosslinks to form a stable clot.
Factor XIII
Activated by thrombin to XIIIa; crosslinks fibrin to stabilize clot.
Tissue Factor Pathway Inhibitor (TFPI)
Inhibits Factor Xa and the complex of tissue factor and Factor VIIa, modulating the extrinsic pathway.
Antithrombin III
Inactivates thrombin and other serine proteases in the coagulation cascade; its activity is enhanced by heparin.
Protein C and Protein S
Together, they inactivate Factors Va and VIIIa, providing a negative feedback mechanism for the cascade.
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