The hemostatic balance revisited through the lessons of mankind evolution.
Under physiologic conditions, a hemostatic balance is achieved through the effects of natural procoagulant and anticoagulant factors which, in equilibrium with each other, provide hemostasis at the sites of vascular injury. Abnormalities of these hemostasis factors can result in a tendency toward hemorrhagic or thrombotic events. In this review the influence of inherited prothrombotic risk factors--especially the more frequent factor V Leiden and prothrombin gene mutations--on normal and abnormal hemostasis is analyzed from an evolutionary point of view. The effect of inherited bleeding disorders on the development of thrombotic or atherosclerotic processes is also discussed.
Franchini
Massimo
M
Transfusion and Hemophilia Center, City Hospital of Verona, Piazzale Ludovico Scuro, 37134 Verona, Italy. massimo.franchini@azosp.vr.it
Mannucci
Pier Mannuccio
PM
D005075:Biological Evolution; D001808:Blood Vessels / Q000293:injuries; D005165:Factor V; D020022:Genetic Predisposition to Disease; D006470:Hemorrhage; D006490:Hemostatics / Q000378:metabolism*; D006801:Humans; D011516:Prothrombin / Q000235:genetics; D020246:Venous Thrombosis
D006490:Hemostatics; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin