microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2022-21-1-78-86microcirculation-1044Research ArticleЛЕКЦИИLECTURESАртериальные и венозные тромбозы. Всегда ли применима триада Вирхова?Arterial and venous thrombosis. Is the Virchow’s triad always valid?ВласовТ. Д.VlasovT. D.

Власов Тимур Дмитриевич – д-р мед. наук, профессор,зав. кафедрой патофизиологии с курсом клинической патофизиологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Vlasov Timur D. – Dr. of Sci. (Med.), professor, head of the Department of Pathophysiology with a course of clinical pathophysiology

6-8, L’va Tolstogo str., Saint Petersburg, 197022

tvlasov@yandex.ruЯшинС. М.YashinS. M.

Яшин Сергей М. – д-р мед. наук, профессор, зав. кафедрой госпитальной хирургии № 2 с клиникой

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Yashin Sergey M. – Dr. of Sci. (Med.), professor, Head of the department of hospital surgery ¹ 2 with clinics

6-8, L’va Tolstogo str., Saint Petersburg, 197022

smyashin@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov UniversityRussian Federation2022110420222117886Copyright © Власов Т.Д., Яшин С.М., 20222022Власов Т.Д., Яшин С.М.Vlasov T.D., Yashin S.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1044

Несмотря на успехи консервативного и оперативного лечения сосудистых заболеваний, задача профилактики артериальных и венозных тромбозов остается чрезвычайно актуальной. Более ста лет для объяснения механизма тромбообразования используется так называемая «триада Вирхова»: 1 – замедление кровотока; 2 – гиперкоагуляция; 3 – повреждение сосудистой стенки. Однако в полной мере сочетание этих факторов применимо для объяснения развития венозных тромбозов; для артерий классическая триада Вирхова имеет ограниченное значение. Общепринятой стратегией профилактики венозных тромбозов является применение антикоагулянтов, в то время как для артериальных – антиагрегантов. В последние годы появились данные о механизмах образования тромбов при высоких скоростях кровотока в областях артериального стеноза, а также о роли тромбоцитов и фактора фон Виллебранда в этом процессе. В представленном обзоре разбираются детали механизма тромбообразования в артериях; введится понятие «артериальная триада», включающая в себя: 1 – стеноз артерии (ускорение кровотока); 2 – тромбоциты (их активация и взаимодействие с фактором фон Виллебранда); 3 – повреждение сосудистой стенки. Артериальная триада описывает механизмы развития тромбоза в артериях на фоне их стенозирования (как правило, вследствие атеросклероза). Понимание общности классической триады Вирхова и артериальной, как и различий между ними, позволит лучше оценить факторы риска у пациентов с сердечно-сосудистой патологией и выработать оптимальные способы их профилактики.

Despite the success of conservative and surgical treatment of vascular diseases, the prevention of arterial and venous thrombosis remains extremely actual. For more than a hundred years, the so-called «Virchow’s triad» has been used to explain the mechanism of thrombosis: 1–slowing of blood flow; 2–hypercoagulation; 3 – damage to the vascular wall. However, the combination of these factors is fully applicable only for venous thrombosis and limited for arterial thrombosis. The generally accepted strategy for the prevention of venous thrombosis is the use of anticoagulants, while for arterial thrombosis – antiaggregants. In recent years the mechanisms of blood clot formation at high blood flow rates in the areas of arterial stenosis, as well as the role of platelets and von Willebrand factor in this process, were investigated. In the presented review, the details of the mechanisms of thrombosis in the arteries are analyzed and the concept of «arterial triad» is introduced. Arterial triad includes: 1 – arterial stenosis (increase in shear rate); 2 – platelets (their activation and interaction with von Willebrand factor); 3 – damage of the vascular wall. The arterial triad describes the mechanisms of thrombosis in the presence of artery stenosis (usually due to atherosclerosis). Understanding similarities and differences between Virchow’s and arterial triads, will allow us to estimate the risk factors in patients with cardiovascular pathology and develop optimal methods of their prevention.

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The authors declare that there are no conflicts of interest present.