Semin Thromb Hemost 2020; 46(01): 096-104
DOI: 10.1055/s-0039-1696944
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clot Structure and Implications for Bleeding and Thrombosis

Emily Mihalko
1   Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, North Carolina
2   Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
,
Ashley C. Brown
1   Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, North Carolina
2   Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
› Author Affiliations
Funding Our work as described in this review was supported by the American Heart Association (16SDG29870005), National Institutes of Health NIAMS (R21AR071017), and the North Carolina State University GAANN Fellowship in Molecular Biotechnology and AHA Pre-doctoral Fellowship (18PRE33990338) to E.M.
Further Information

Publication History

Publication Date:
15 October 2019 (online)

Abstract

The formation of a fibrin clot matrix plays a critical role in promoting hemostasis and wound healing. Fibrin dynamics can become disadvantageous in the formation of aberrant thrombus development. Structural characteristics of clots, such as fiber diameter, clot density, stiffness, or permeability, can determine overall clot integrity and functional characteristics that have implications on coagulation and fibrinolysis. This review examines known factors that contribute to changes in clot structure and the presence of structural clot changes in various disease states. These insights provide valuable information in forming therapeutic strategies for disease states where alterations in clot structure are observed. Additionally, the implications of structural changes in clot networks on bleeding and thrombus development in terms of disease states and clinical outcomes are also examined in this review.

 
  • References

  • 1 Weisel JW. Structure of fibrin: impact on clot stability. J Thromb Haemost 2007; 5 (Suppl. 01) 116-124
  • 2 Lord ST. Fibrinogen and fibrin: scaffold proteins in hemostasis. Curr Opin Hematol 2007; 14 (03) 236-241
  • 3 Weisel JW. Fibrinogen and fibrin. Adv Protein Chem 2005; 70: 247-299
  • 4 Wolberg AS, Campbell RA. Thrombin generation, fibrin clot formation and hemostasis. Transfus Apheresis Sci 2008; 38 (01) 15-23
  • 5 Furlan M, Seelich T, Beck EA. Clottability and cross-linking reactivity of fibrin(ogen) following differential release of fibrinopeptides A and B. Thromb Haemost 1976; 36 (03) 582-592
  • 6 Litvinov RI, Gorkun OV, Owen SF, Shuman H, Weisel JW. Polymerization of fibrin: specificity, strength, and stability of knob-hole interactions studied at the single-molecule level. Blood 2005; 106 (09) 2944-2951
  • 7 Doolittle RF, Pandi L. Binding of synthetic B knobs to fibrinogen changes the character of fibrin and inhibits its ability to activate tissue plasminogen activator and its destruction by plasmin. Biochemistry 2006; 45 (08) 2657-2667
  • 8 Stabenfeldt SE, Gourley M, Krishnan L, Hoying JB, Barker TH. Engineering fibrin polymers through engagement of alternative polymerization mechanisms. Biomaterials 2012; 33 (02) 535-544
  • 9 Brown AC, Baker SR, Douglas AM. , et al. Molecular interference of fibrin's divalent polymerization mechanism enables modulation of multiscale material properties. Biomaterials 2015; 49: 27-36
  • 10 Ferry JD, Morrison PR. Preparation and properties of serum and plasma proteins; the conversion of human fibrinogen to fibrin under various conditions. J Am Chem Soc 1947; 69 (02) 388-400
  • 11 Sproul EP, Hannan RT, Brown AC. Controlling fibrin network morphology, polymerization, and degradation dynamics in fibrin gels for promoting tissue repair. In: Chawla K. , ed. Biomaterials for Tissue Engineering: Methods and Protocols. Methods in Molecular Biology. New York, NY: Springer New York; 2018: 85-99
  • 12 Wolberg AS. Thrombin generation and fibrin clot structure. Blood Rev 2007; 21 (03) 131-142
  • 13 Carr Jr ME, Hermans J. Size and density of fibrin fibers from turbidity. Macromolecules 1978; 11 (01) 46-50
  • 14 Yeromonahos C, Polack B, Caton F. Nanostructure of the fibrin clot. Biophys J 2010; 99 (07) 2018-2027
  • 15 Nellenbach K, Guzzetta NA, Brown AC. Analysis of the structural and mechanical effects of procoagulant agents on neonatal fibrin networks following cardiopulmonary bypass. J Thromb Haemost 2018; 16 (11) 2159-2167
  • 16 Brown AC, Hannan RT, Timmins LH, Fernandez JD, Barker TH, Guzzetta NA. Fibrin network changes in neonates after cardiopulmonary bypass. Anesthesiology 2016; 124 (05) 1021-1031
  • 17 Mihalko E, Huang K, Sproul E, Cheng K, Brown AC. Targeted treatment of ischemic and fibrotic complications of myocardial infarction using a dual-delivery microgel therapeutic. ACS Nano 2018; 12 (08) 7826-7837
  • 18 Fogelson AL, Keener JP. Toward an understanding of fibrin branching structure. Phys Rev E Stat Nonlin Soft Matter Phys 2010; 81 (5 Pt 1): 051922
  • 19 Carr Jr ME, Alving BM. Effect of fibrin structure on plasmin-mediated dissolution of plasma clots. Blood Coagul Fibrinolysis 1995; 6 (06) 567-573
  • 20 Gabriel DA, Muga K, Boothroyd EM. The effect of fibrin structure on fibrinolysis. J Biol Chem 1992; 267 (34) 24259-24263
  • 21 Collet JP, Park D, Lesty C. , et al. Influence of fibrin network conformation and fibrin fiber diameter on fibrinolysis speed: dynamic and structural approaches by confocal microscopy. Arterioscler Thromb Vasc Biol 2000; 20 (05) 1354-1361
  • 22 Blombäck B, Okada M. Fibrin gel structure and clotting time. Thromb Res 1982; 25 (1-2): 51-70
  • 23 Pieters M, Undas A, Marchi R, De Maat MP, Weisel J, Ariëns RA. ; Factor XIII and Fibrinogen Subcommittee of the Scientific Standardisation Committee of the International Society for Thrombosis and Haemostasis. An international study on the standardization of fibrin clot permeability measurement: methodological considerations and implications for healthy control values. J Thromb Haemost 2012; 10 (10) 2179-2181
  • 24 Welsch N, Brown AC, Barker TH, Lyon LA. Enhancing clot properties through fibrin-specific self-cross-linked PEG side-chain microgels. Colloids Surf B Biointerfaces 2018; 166: 89-97
  • 25 Münster S, Jawerth LM, Fabry B, Weitz DA. Structure and mechanics of fibrin clots formed under mechanical perturbation. J Thromb Haemost 2013; 11 (03) 557-560
  • 26 Ząbczyk M, Undas A. Plasma fibrin clot structure and thromboembolism: clinical implications. Pol Arch Intern Med 2017; 127 (12) 873-881
  • 27 Blombäck B, Carlsson K, Fatah K, Hessel B, Procyk R. Fibrin in human plasma: gel architectures governed by rate and nature of fibrinogen activation. Thromb Res 1994; 75 (05) 521-538
  • 28 Colle JP, Mishal Z, Lesty C. , et al. Abnormal fibrin clot architecture in nephrotic patients is related to hypofibrinolysis: influence of plasma biochemical modifications: a possible mechanism for the high thrombotic tendency?. Thromb Haemost 1999; 82 (05) 1482-1489
  • 29 Hethershaw EL, Cilia La Corte AL, Duval C. , et al. The effect of blood coagulation factor XIII on fibrin clot structure and fibrinolysis. J Thromb Haemost 2014; 12 (02) 197-205
  • 30 Konings J, Govers-Riemslag JW, Philippou H. , et al. Factor XIIa regulates the structure of the fibrin clot independently of thrombin generation through direct interaction with fibrin. Blood 2011; 118 (14) 3942-3951
  • 31 Rosser RW, Roberts WW, Ferry JD. Rheology of fibrin clots. IV. Darcy constants and fiber thickness. Biophys Chem 1977; 7 (02) 153-157
  • 32 Weisel JW, Nagaswami C. Computer modeling of fibrin polymerization kinetics correlated with electron microscope and turbidity observations: clot structure and assembly are kinetically controlled. Biophys J 1992; 63 (01) 111-128
  • 33 Smith SA, Morrissey JH. Polyphosphate enhances fibrin clot structure. Blood 2008; 112 (07) 2810-2816
  • 34 Carr Jr ME, Gabriel DA, McDonagh J. Influence of Ca2+ on the structure of reptilase-derived and thrombin-derived fibrin gels. Biochem J 1986; 239 (03) 513-516
  • 35 Weigandt KM, White N, Chung D. , et al. Fibrin clot structure and mechanics associated with specific oxidation of methionine residues in fibrinogen. Biophys J 2012; 103 (11) 2399-2407
  • 36 Ossipova E, Malmström V, Catrina AI, Klareskog L, Zubarev R, Jakobsson P-J. Identification of specific citrullination sites on fibrinogen in RA. Ann Rheum Dis 2010; 69 (Suppl. 02) A4-A5
  • 37 van Beers JJ, Raijmakers R, Alexander L-E. , et al. Mapping of citrullinated fibrinogen B-cell epitopes in rheumatoid arthritis by imaging surface plasmon resonance. Arthritis Res Ther 2010; 12 (06) R219
  • 38 Stefanelli VL, Barker TH. Provisional matrix citrullination contributes to enhanced fibroblast migration. Biophys J 2016; 110 (03) 305a
  • 39 Weisel JW. The mechanical properties of fibrin for basic scientists and clinicians. Biophys Chem 2004; 112 (2-3): 267-276
  • 40 Allen GA, Wolberg AS, Oliver JA, Hoffman M, Roberts HR, Monroe DM. Impact of procoagulant concentration on rate, peak and total thrombin generation in a model system. J Thromb Haemost 2004; 2 (03) 402-413
  • 41 von dem Borne PA, Meijers JC, Bouma BN. Feedback activation of factor XI by thrombin in plasma results in additional formation of thrombin that protects fibrin clots from fibrinolysis. Blood 1995; 86 (08) 3035-3042
  • 42 Zucker M, Seligsohn U, Salomon O, Wolberg AS. Abnormal plasma clot structure and stability distinguish bleeding risk in patients with severe factor XI deficiency. J Thromb Haemost 2014; 12 (07) 1121-1130
  • 43 Lisman T, Ariëns RAS. Alterations in fibrin structure in patients with liver diseases. Semin Thromb Hemost 2016; 42 (04) 389-396
  • 44 Hugenholtz GC, Macrae F, Adelmeijer J. , et al. Procoagulant changes in fibrin clot structure in patients with cirrhosis are associated with oxidative modifications of fibrinogen. J Thromb Haemost 2016; 14 (05) 1054-1066
  • 45 Undas A, Zawilska K, Ciesla-Dul M. , et al. Altered fibrin clot structure/function in patients with idiopathic venous thromboembolism and in their relatives. Blood 2009; 114 (19) 4272-4278
  • 46 Maresca G, Di Blasio A, Marchioli R, Di Minno G. Measuring plasma fibrinogen to predict stroke and myocardial infarction: an update. Arterioscler Thromb Vasc Biol 1999; 19 (06) 1368-1377
  • 47 Scrutton MC, Ross-Murphy SB, Bennett GM, Stirling Y, Meade TW. Changes in clot deformability--a possible explanation for the epidemiological association between plasma fibrinogen concentration and myocardial infarction. Blood Coagul Fibrinolysis 1994; 5 (05) 719-723
  • 48 Henschen-Edman AH. Fibrinogen non-inherited heterogeneity and its relationship to function in health and disease. Ann N Y Acad Sci 2001; 936 (01) 580-593
  • 49 Cawthern KM, van 't Veer C, Lock JB, DiLorenzo ME, Branda RF, Mann KG. Blood coagulation in hemophilia A and hemophilia C. Blood 1998; 91 (12) 4581-4592
  • 50 Luong V, Soutari N, Berndtsson M, Holmström M, Antovic JP, Chaireti R. Difference in fibrin clot structure in haemophilia A and haemophilia B. Blood 2016; 128 (22) 563
  • 51 Fries D, Krismer A, Klingler A. , et al. Effect of fibrinogen on reversal of dilutional coagulopathy: a porcine model. Br J Anaesth 2005; 95 (02) 172-177
  • 52 Undas A, Wiek I, Stêpien E, Zmudka K, Tracz W. Hyperglycemia is associated with enhanced thrombin formation, platelet activation, and fibrin clot resistance to lysis in patients with acute coronary syndrome. Diabetes Care 2008; 31 (08) 1590-1595
  • 53 Undas A. Prothrombotic fibrin clot phenotype in patients with deep vein thrombosis and pulmonary embolism: a new risk factor for recurrence. BioMed Res Int 2017; 2017: 1-9
  • 54 Drabik L, Wołkow P, Undas A. Fibrin clot permeability as a predictor of stroke and bleeding in anticoagulated patients with atrial fibrillation. Stroke 2017; 48 (10) 2716-2722
  • 55 Natorska J, Wypasek E, Grudzień G, Sadowski J, Undas A. Impaired fibrinolysis is associated with the severity of aortic stenosis in humans. J Thromb Haemost 2013; 11 (04) 733-740
  • 56 Baker SR, Zabczyk M, Macrae FL, Duval C, Undas A, Ariëns RAS. Recurrent venous thromboembolism patients form clots with lower elastic modulus than those with non-recurrent disease. J Thromb Haemost 2019; 17 (04) 618-626
  • 57 Mills JD, Ariëns RA, Mansfield MW, Grant PJ. Altered fibrin clot structure in the healthy relatives of patients with premature coronary artery disease. Circulation 2002; 106 (15) 1938-1942