Section of Clinical Biochemistry, University of Verona, Verona, Italy.
Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research, Westmead, Australia.
Semin Thromb Hemost. 2018 Apr;44(3):239-248. doi: 10.1055/s-0037-1607202. Epub 2017 Sep 25.
Arterial and venous thromboses are sustained by development of intraluminal thrombi, respectively, within the venous and arterial systems. The composition and structure of arterial and venous thrombi have been historically considered as being very different. Arterial thrombi (conventionally defined as "white") have been traditionally proposed to be composed mainly of fibrin and platelet aggregates, whilst venous thrombi (conventionally defined as "red") have been proposed as mostly being enriched in fibrin and erythrocytes. This archaic dichotomy seems ever more questionable, since it barely reflects the pathophysiology of thrombus formation in vivo. Both types of thrombi are actually composed of a complex fibrin network but, importantly, also contain essentially the same blood-borne cells (i.e., red blood cells, leukocytes, and platelets), and it is only the relative content of these individual elements that differ between venous and arterial clots or, otherwise, between thrombi generated under different conditions of blood flow and shear stress. Convincing evidence now suggests that either white or red intracoronary thrombi may be present in patients with myocardial infarction and, even more importantly, red thrombi may be more prone to distal embolization during percutaneous coronary intervention than those with lower content of erythrocytes. Conversely, it is now accepted that components traditionally considered to be involved "only" in arterial thrombosis are also represented in venous thrombosis. Thus, platelets comprise important components of venous clots, although they may be present in lower amounts here than in arterial thrombi, and von Willebrand factor is also represented in both arterial and venous thrombi. Of importance, such evidence thus supports the concept that adjunctive treatment normally associated to prevention of arterial thrombosis (e.g., aspirin) may have a role also in prevention and treatment of venous thrombosis.
动脉血栓和静脉血栓分别由静脉和动脉系统内的管腔内血栓形成维持。动脉血栓（传统定义为“白色”）和静脉血栓（传统定义为“红色”）的组成和结构一直被认为非常不同。传统上认为动脉血栓（通常定义为“白色”）主要由纤维蛋白和血小板聚集物组成，而静脉血栓（通常定义为“红色”）则主要富含纤维蛋白和红细胞。这种古老的二分法似乎越来越值得怀疑，因为它几乎不能反映体内血栓形成的病理生理学。实际上，这两种类型的血栓都由复杂的纤维蛋白网络组成，但重要的是，它们还包含基本相同的血液来源细胞（即红细胞、白细胞和血小板），并且静脉和动脉血栓之间或在不同血流和剪切应力条件下形成的血栓之间的差异仅在于这些单个元素的相对含量。现在有令人信服的证据表明，心肌梗死患者可能存在白色或红色的冠状动脉内血栓，更重要的是，与红细胞含量较低的血栓相比，红色血栓在经皮冠状动脉介入治疗期间更可能发生远端栓塞。相反，现在人们接受了这样一个概念，即传统上认为仅与动脉血栓形成有关的成分也存在于静脉血栓形成中。因此，血小板是静脉血栓的重要组成部分，尽管它们在静脉血栓中的含量可能低于动脉血栓，而血管性血友病因子也存在于动脉和静脉血栓中。重要的是，这些证据支持这样一种概念，即通常与预防动脉血栓形成相关的辅助治疗（例如阿司匹林）也可能在预防和治疗静脉血栓形成中发挥作用。
