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# Thrombosis and Virchow's triad

- Mechanism

A thrombus is a clot that forms inside a living vessel. It comes from endothelial damage, abnormal flow or blood that clots too easily.

Updated 2026-11-01

## Key points

- Virchow’s triad: endothelial injury, abnormal flow (stasis or turbulence), hypercoagulability.
- Arteries and heart: endothelial injury dominates (atheromatous plaque, infarcted endocardium).
- Veins: stasis dominates (immobility, surgery, long journeys, heart failure).
- Healthy endothelium is antithrombotic: prostacyclin, nitric oxide, thrombomodulin, heparin-like molecules and tissue plasminogen activator.
- Atrial fibrillation: stasis in the left atrial appendage, the main source of emboli to the brain.

## What it is

Thrombosis is hemostasis switched on in the wrong place at the wrong time: inside an intact vessel, or in response to a small injury. Virchow described the three factors that favour it: endothelial injury, abnormal flow (stasis or turbulence) and hypercoagulability. In arteries and the heart endothelial injury dominates; in veins, stasis. Thrombi cause infarcts and emboli, the leading causes of death worldwide.

## Step by step

- The endothelium is injured or activated (cytokines, turbulent flow, tobacco toxins).
- Platelets stick to exposed collagen through von Willebrand factor.
- They activate, release ADP and thromboxane A2 and recruit more platelets.
- Tissue factor starts the cascade; thrombin turns fibrinogen into fibrin.
- Stasis keeps activated factors from being washed away and inhibitors from arriving.
- The thrombus grows if formation outpaces fibrinolysis; it may occlude or break off.

## Virchow’s triad in practice

| Factor | What happens | Examples |
| --- | --- | --- |
| Endothelial injury | Collagen and tissue factor are exposed; antithrombotic protection is lost | Ruptured atheromatous plaque, myocardial infarction, vasculitis, catheters, smoking |
| Stasis | Platelets touch the wall; activated factors are not diluted | Immobility, varicose veins, atrial fibrillation, aneurysms, dilated ventricle |
| Turbulence | Damages the endothelium and creates pockets of stasis | Arterial branch points, diseased valves |
| Hypercoagulability | More clotting factors or fewer natural anticoagulants | Factor V Leiden, cancer, pregnancy, estrogens, antiphospholipid syndrome |

## Clinical notes

- Deep vein thrombosis after orthopaedic surgery, childbirth or immobilisation: stasis is the main factor.
- Myocardial infarction: thrombosis on a ruptured atheromatous plaque in a coronary artery.
- Polycythemia vera: thick blood (hyperviscosity) causes stasis in small vessels.

## Memory aid

Wall, stream and blood: when any of the three fails, blood sets where it should not.

## Test yourself

Think of the answer, then tap the question to see it.

## What are the three parts of Virchow’s triad?

Endothelial injury, abnormal blood flow (stasis or turbulence) and hypercoagulability.

## Which part of the triad dominates in deep vein thrombosis?

Venous stasis, for example from immobility or surgery.

## Which molecule ties platelets to subendothelial collagen?

Von Willebrand factor, which binds platelet glycoprotein Ib.

## Why does atrial fibrillation predispose to thrombosis?

Because the atrium does not contract well and blood stagnates, above all in the left atrial appendage.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/thrombosis-and-virchow-s-triad/)

## Related

- [Hypercoagulable states: inherited and acquired](https://durgical.com/en/general-pathology/hypercoagulable-states-inherited-and-acquired/)
- [Arterial vs venous thrombi; mural thrombi and lines of Zahn](https://durgical.com/en/general-pathology/arterial-vs-venous-thrombi-mural-thrombi-and-lines-of-zahn/)
- [What happens to a thrombus: propagation, embolism, dissolution, organization](https://durgical.com/en/general-pathology/what-happens-to-a-thrombus-propagation-embolism-dissolution-organization/)
- [Pulmonary thromboembolism: where it comes from and what it does](https://durgical.com/en/general-pathology/pulmonary-thromboembolism-where-it-comes-from-and-what-it-does/)
- [Systemic (arterial) thromboembolism](https://durgical.com/en/general-pathology/systemic-thromboembolism/)

## Related conditions

- [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Cerebral venous sinus thrombosis](https://durgical.com/en/conditions/cerebral-venous-sinus-thrombosis/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/)
- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)
- [Portal vein thrombosis](https://durgical.com/en/conditions/portal-vein-thrombosis/)
- [Renal vein thrombosis](https://durgical.com/en/conditions/renal-vein-thrombosis/)
- [Budd-Chiari syndrome](https://durgical.com/en/conditions/budd-chiari-syndrome/)
- [Abdominal aortic aneurysm](https://durgical.com/en/conditions/abdominal-aortic-aneurysm/)
- [Polycythaemia vera](https://durgical.com/en/conditions/polycythaemia-vera/)
- [Superficial thrombophlebitis (superficial vein thrombosis)](https://durgical.com/en/conditions/superficial-thrombophlebitis/)

## Elsewhere in DurgiPedia

- [Thrombosis and bleeding: Virchow's triad and hemostatic defects](https://durgical.com/en/physiology/thrombosis-and-bleeding-virchow-s-triad-and-hemostatic-defects/)
- [The coagulation cascade](https://durgical.com/en/physiology/the-coagulation-cascade/)
- [Primary hemostasis and platelets](https://durgical.com/en/physiology/primary-hemostasis-and-platelets/)
- [Fibrinolysis and natural anticoagulants](https://durgical.com/en/physiology/fibrinolysis-and-natural-anticoagulants/)
- [Nitric oxide (NO)](https://durgical.com/en/biochemistry/molecules/nitric-oxide/)
- [Thromboxane A₂ (TXA₂)](https://durgical.com/en/biochemistry/molecules/thromboxane-a/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [About Venous Thromboembolism (Blood Clots)](https://www.cdc.gov/blood-clots/about/index.html) (Centers for Disease Control and Prevention (CDC), 2025); [Venous Thromboembolism - What Is Venous Thromboembolism? | NHLBI, NIH](https://www.nhlbi.nih.gov/health/venous-thromboembolism) (National Heart, Lung, and Blood Institute (NHLBI), 2022); [Blood Clots | Hypercoagulability | MedlinePlus](https://medlineplus.gov/bloodclots.html) (MedlinePlus, US National Library of Medicine, 2023).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/thrombosis-and-virchow-s-triad/