General pathology · Hemodynamic disorders
What happens to a thrombus: propagation, embolism, dissolution, organization !
- Process
A thrombus can grow, break off and travel, dissolve, or turn into scar tissue that sometimes lets blood through again.
Updated 2026-11-01
What it is
Once formed, a thrombus has four possible fates. It can propagate and block more of the vessel; break off wholly or in part and embolise; dissolve through fibrinolysis, which works well only on recent thrombi; or organise, being invaded by cells and new vessels until it becomes fibrous tissue, sometimes with channels that restore some flow (recanalization). This is why thrombolytic treatment works best in the first hours.
Step by step
- The thrombus forms on the vessel wall.
- Propagation: more platelets and fibrin are added and the thrombus lengthens along the vessel.
- Embolization: a fragment breaks off and travels in the blood to a smaller vessel.
- Dissolution: plasmin breaks down fibrin; it works in thrombi hours to a few days old.
- Organization: over days to weeks endothelial cells, smooth muscle and fibroblasts grow into the thrombus.
- Recanalization: new channels form and give back part of the flow.
- In the end a fibrous scar is incorporated into the vessel wall.
Clinical notes
- After a deep vein thrombosis, destroyed valves cause chronic venous insufficiency and venous ulcers.
- Pulmonary emboli that do not dissolve and organise can cause chronic thromboembolic pulmonary hypertension.
- Anticoagulation does not dissolve the thrombus: it stops it growing while the body’s own fibrinolysis works.
Test yourself
Think of the answer, then tap the question to see it.
What are the four fates of a thrombus?
Propagation, embolization, dissolution by fibrinolysis, and organization with recanalization.
Why does thrombolysis work best on recent thrombi?
Because recent fibrin is not yet cross-linked or invaded by cells, and plasmin breaks it down easily.
What is recanalization?
The formation of new endothelium-lined channels inside an organised thrombus that restore part of the flow.
Which sequel often follows a deep vein thrombosis?
Post-thrombotic syndrome: damaged valves, chronic edema, skin changes and venous ulcers.
Related
- Thrombosis and Virchow's triad
- Arterial vs venous thrombi; mural thrombi and lines of Zahn
- Pulmonary thromboembolism: where it comes from and what it does
- Granulation tissue and scar formation
Related conditions
- Deep vein thrombosis
- Pulmonary embolism
- Chronic venous insufficiency
- Venous leg ulcer
- Pulmonary hypertension and cor pulmonale
- Infective endocarditis
Elsewhere in DurgiPedia
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: Venous Thromboembolism - What Is Venous Thromboembolism? | NHLBI, NIH (National Heart, Lung, and Blood Institute (NHLBI), 2022); Pulmonary embolus: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.