Helgason Cathy M
Department of Neurology, University of Illinois College of Medicine at Chicago, 912 South Wood Street, Room 855N, Chicago, IL 60612, USA.
Curr Treat Options Cardiovasc Med. 2006 May;8(3):259-66. doi: 10.1007/s11936-006-0020-z.
The current understanding of thrombogenesis is modeled on Virchow's triad: stasis, hypercoagulability, and vessel wall injury. There is a dynamic (always changing) nonlinear interaction between the vascular wall, blood components, and flow, which at times defined "pathologic" leads to thrombosis or hemorrhage, at other times called "healthy" to normal hemostasis. The triad named after Virchow was not designated as such in Virchow's work. Instead, Virchow showed that thrombosis itself leads to endothelial damage, hypercoagulability, and stasis. Thus, cause and effect regarding the elements of Virchow's triad and thrombosis become indistinguishable if linearity is considered mandatory. Considering a nonlinear relation solves this problem. In the real patient, each element is present to a degree. At every moment in time, the direction of coagulation (toward hemostasis, thrombosis, or hemorrhage) and the dynamic of interaction of the elements of the triad change. The complexity and nonlinearity of the thrombotic context is evident. These facts suggest a new venue for diagnostic classification of stroke (ischemic and hemorrhagic) by causation and have implications for its prevention and treatment. Clinical and laboratory evidence can be gathered for the elements of Virchow's triad as well as for fibrinolysis and thrombosis. Mathematical methods other than probability-based statistics can represent the measured presence of these elements to a degree and their nonlinear relationship. These include, but may not be limited to, Riemannian geometry, fuzzy logic, cellular automata, and infinitesimals, all proscribed by evidence-based medicine. However, by using these methods, diagnosis and treatment measures for stroke can be built on a causal rather than risk methodology, individualizing medical decisions to the patient. All current clinical guidelines are based on linear methods of probability-based statistics and group-based data. The therapeutic choice of antithrombotic therapy in the individual patient for whom measured elements of thrombogenesis are available rests on the knowledge and expertise of the treating physician.
血流淤滞、高凝状态和血管壁损伤。血管壁、血液成分和血流之间存在动态（不断变化）的非线性相互作用，这种相互作用有时导致定义为“病理性”的血栓形成或出血，有时则称为“健康状态”下的正常止血。以魏尔啸命名的三要素在他的著作中并非如此命名。相反，魏尔啸指出血栓形成本身会导致内皮损伤、高凝状态和血流淤滞。因此，如果认为线性关系是必然的，那么关于魏尔啸氏三要素与血栓形成之间的因果关系就变得难以区分。考虑非线性关系可以解决这个问题。在实际患者中，每个要素都在一定程度上存在。在每个时刻，凝血的方向（朝向止血、血栓形成或出血）以及三要素之间相互作用的动态都会发生变化。血栓形成情况的复杂性和非线性是显而易见的。这些事实为按病因对中风（缺血性和出血性）进行诊断分类提供了新途径，并对其预防和治疗具有启示意义。可以收集关于魏尔啸氏三要素以及纤维蛋白溶解和血栓形成的临床和实验室证据。除了基于概率的统计方法外，其他数学方法可以在一定程度上表示这些要素的测量存在及其非线性关系。这些方法包括但不限于黎曼几何、模糊逻辑、细胞自动机和无穷小量，所有这些都被循证医学所摒弃。然而，通过使用这些方法，中风的诊断和治疗措施可以基于因果关系而非风险方法构建，使医疗决策针对个体患者进行个性化。所有当前的临床指南都是基于基于概率的统计线性方法和基于群体的数据。对于可获得血栓形成测量要素的个体患者，抗血栓治疗的治疗选择取决于治疗医生的知识和专业技能。
