ABSTRACT
The safe practice of surgery requires a fundamental understanding of the concepts of hemostasis. Traditionally, standard textbooks of surgery have focused on the basics of the coagulation pathways and platelet function, with an overview of inherited and acquired defects of these mechanisms. In organizing this chapter, we have sought to summarize these basic concepts and provide additional information on more recent developments that have enhanced our understanding of hemostasis in vivo. The central roles of the tissue factor pathway and thrombin in the coagulation cascade, for example, are emphasized. In addition, newer information on the hypercoagulable syndromes and their role in thrombotic disorders are also presented. Developments in molecular biology are providing unprecedented insight and fundamental understanding of the genetics of inherited bleeding and hypercoagulable disorders that have translated into improved diagnostic testing, such as with resistance to activated protein C and hyperhomocystinemia. Similarly, as the molecular mechanisms of hemostasis are increasingly understood, potent antiplatelet and antithrombotic agents are being developed and made available for clinical use. An appreciation of their therapeutic potential and challenge to surgical hemostasis requires a basic understanding of their mechanisms of action.
