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Figure 8: Schema of atherothrombus growth. Atherothrombus formation is initiated by plaque disruption and exposure of matrix proteins and tissue factor (TF). This induces initial platelet (Plt) adhesion/aggregation and activation of coagulation cascade. Thrombin (IIa) activates factor XI, factor VIII, and factor V on activated platelets, which amplify thrombin generation. Excess thrombin generation enhances fibrin formation and platelet aggregation on atherosclerotic plaque. The thrombin-dependent thrombus formation is mediated by plaque TF. Disturbed blood flow also promotes coagulation cascade and platelet recruitment by von Willebrand factor (VWF). The platelet recruitment is negatively regulated by ADAMTS-13 (a disintegrin and a metalloprotease with a thrombospondin type 1 motif 13).