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Virchow's triad

Three factors thought to cause internal blood clots (thrombosis)

Field	Value
image	Virchow's Triad.svg
caption	Virchow's triad
specialty
differential	thrombosis

Virchow's triad or the triad of Virchow () describes the three broad categories of factors that are thought to contribute to thrombosis.{{cite book

Hypercoagulability
Hemodynamic changes (stasis, turbulence)
Endothelial injury/dysfunction

It is named after the renowned German physician Rudolf Virchow (1821–1902). However, the elements comprising Virchow's triad were not proposed by Virchow. Neither did he ever suggest a triad to describe the pathogenesis of venous thrombosis. In fact, it was not until decades after Virchow's death that a consensus was reached proposing that thrombosis is the result of alterations in blood flow, vascular endothelial injury, or alterations in the constitution of the blood. Still, the modern understanding of the factors leading to embolism is similar to the description provided by Virchow. Virchow's triad remains a useful concept for clinicians and pathologists alike in understanding the contributors to thrombosis.{{cite journal TOC

The triad

The triad consists of three components:

Virchow's{{cite book	Modern	Notes
author=Malone, P. Colm, Agutter, Paul S.	title=The Aetiology of Deep Venous Thrombosis: A Critical, Historical and Epistemological Survey	publisher=Springer
Phenomena of interrupted blood-flow	Stasis {{cite journal	author=Lowe GD
Phenomena associated with irritation of the vessel and its vicinity	Endothelial injury or vessel wall injury	The second category, injuries and/or trauma to endothelium includes vessel piercings and damages arising from shear stress or hypertension. This category is ruled by surface phenomena and contact with procoagulant surfaces, such as bacteria, shards of foreign materials, biomaterials of implants or medical devices, membranes of activated platelets, and membranes of monocytes in chronic inflammation.
Phenomena of blood-coagulation	Hypercoagulability	The last category, alterations in the constitution of blood,{{cite journal

History

The origin of the term "Virchow's Triad" is of historical interest, and has been subject to reinterpretation in recent years.{{cite journal |access-date=2012-05-09 |archive-date=2016-03-05 |archive-url=https://web.archive.org/web/20160305060746/http://utmj.org/archive/81-3/HIST.pdf |url-status=dead |access-date=2009-02-10 |archive-date=2016-03-03 |archive-url=https://web.archive.org/web/20160303182629/http://www.thefreelibrary.com/Response%3A+further+reflections+on+Virchow%27s+Triad.%28Letter+to+the...-a0128075136 |url-status=dead

Rudolf Virchow elucidated the etiology of pulmonary embolism, whereby thrombi occurring within the veins, particularly those of the extremities, become dislodged and migrate to the pulmonary vasculature. He published his description in 1856.{{cite book |access-date=2009-02-10 |archive-date=2016-03-04 |archive-url=https://web.archive.org/web/20160304100549/http://www.thefreelibrary.com/Virchow%27s+triad%3F-a0123332713 |url-status=dead

Although the concept of the triad is usually attributed to Virchow, he did not include endothelial injury in his description. This has been attributed to a dispute Virchow had with Jean Cruveilhier, who considered local trauma of primary importance in the development of pulmonary artery thrombosis.{{cite web |access-date=2009-02-10 |archive-date=2016-03-03 |archive-url=https://web.archive.org/web/20160303230758/http://www.thefreelibrary.com/Virchow%27s+triad+revisited.%28Letters+to+the+Editor%29%28Letter+to+the...-a0114134751 |url-status=dead

References

Wiseman R. ''Several Chirurgical Treatises''. (2nd ed.) London, Norton and Macock, 1686, pp. 64–66.
{{WhoNamedIt. synd. 1223
Aschoff L. ''Thrombosis, in Lectures on Pathology''. New York, Paul B. Hoeber, Inc., 1924, pp 253–278.

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