Ultrastructural Study Of Experimental Venous Thrombosis
Venous stasis is known to be a necessary but usually not a sufficient cause of venous thrombogenesis. The nature of the additional factor(s) required is uncertain, but the two most likely candidates are local generation of thrombin and vessel wall damage. Autopsy studies show that most venous thrombi develop in apparently normal vessels, although this evidence is based primarily on light microscopy. If thrombin generation is the additional factor, it is uncertain whether such thrombin acts solely on the blood or also damages the endothelium, leading to platelet deposition on exposed subendothelium. We studied the effect of locally injected thrombin on the jugular veins of rabbits, using transmission and scanning electronmicroscopy. One unit of thrombin was sufficient to clot blood contained in an isolated venous segment within a few minutes. The thrombus so formed was then embolised and autologous 11 indium-labelled platelets were injected. Blood flow was re-established for 30 minutes, following which the venous segment was fixed in situ and removed for study.We found no evidence of significant vessel wall damage, as judged by ultrastructural studies or the deposition of labelled platelets. At least 10 u. of injected thrombin were required before the radioactivity in the thrombosed segment exceeded that found in a control vein. Even then, the endothelial lining appeared intact by electronmicroscopy. Following administration of aspirin (10 mg/kg) there was a marked increase in radioactivity present in the thrombosed venous segment, suggesting that inhibition of vessel wall cyclo-oxygenase had led to increased platelet deposition. We conclude that a fresh stasis thrombus resulting from the direct action of thrombin on platelets and fibrinogen does not damage the endothelium, which appears to be relatively resistant in vivo to even high local concentrations of thrombin.