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The Coagulation Cascade

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Thrombin

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Converts fibrinogen to fibrin, activates platelets, and amplifies coagulation by feedback activation of factors V, VIII, and XI.

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Antithrombin III

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Inactivates thrombin and other serine proteases in the coagulation cascade; its activity is enhanced by heparin.

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Extrinsic Pathway Initiation

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Activated by external trauma leading to blood escaping the vascular system; Tissue factor (TF) binds with Factor VII, which is then activated to VIIa.

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Common Pathway Initiation

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Begins after intrinsic and extrinsic pathways converge; Factor X is activated to Xa.

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Factor IX

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Activated to IXa in the intrinsic pathway; assists in converting Factor X to Xa.

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Factor XIII

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Activated by thrombin to XIIIa; crosslinks fibrin to stabilize clot.

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Factor VII

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Activated to VIIa by Tissue Factor (TF) in the extrinsic pathway; helps activate Factor X.

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Tissue Factor Pathway Inhibitor (TFPI)

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Inhibits Factor Xa and the complex of tissue factor and Factor VIIa, modulating the extrinsic pathway.

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Factor VIII

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Acts as a cofactor for Factor IXa in the intrinsic pathway; aids in activating Factor X.

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Factor X

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Activated to Xa in the common pathway; forms part of the prothrombinase complex which converts prothrombin to thrombin.

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Fibrinogen to Fibrin Conversion

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Thrombin cleaves fibrinogen to form fibrin, which then polymerizes and crosslinks to form a stable clot.

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Prothrombin Activation

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Prothrombin (Factor II) is converted to thrombin (IIa) by the prothrombinase complex.

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Protein C and Protein S

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Together, they inactivate Factors Va and VIIIa, providing a negative feedback mechanism for the cascade.

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Intrinsic Pathway Initiation

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Activated by damage inside the vascular system; Factor XII is activated to XIIa.

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