The behavior of platelets at foreign surfaces

Many conditions affect the interaction of platelets with foreign surfaces, including the type of surface, modifications of the surface, conditions of blood flow, the adsorbed layer of plasma proteins, changes in this protein layer with time, and the animal species in which experiments are done. Platelets probably never adhere directly to a foreign surface in vivo, because upon exposure of the surface to blood, plasma proteins, principally fibrinogen, are adsorbed almost immediately. When platelets adhere to such a surface and spread on it, they are activated in much the same way as when they are exposed to a strong aggregating and release-inducing agent, but in contrast to aggregation caused by some agonists, adhesion is not dependent on the formation of TXA2 or the release of ADP. It does appear to depend on external Ca2+. Much less is known about the initial adhesion reaction than about platelet aggregation (thrombus formation) on the adherent platelets, although the morphological changes resulting from adhesion have been described. It is surmised that the metabolic and cytoskeletal changes upon adhesion are similar to those that are involved in the response of platelets to other activating agents. The consequences of adhesion include the formation of thrombi and thromboemboli, thrombocytopenia, reduced platelet survival, reduced platelet function in response to hemostatic stimuli, and the appearance in the circulation of products released or formed by activated platelets. Many efforts are being made to develop surfaces and to set up conditions that will minimize platelet adhesion, but it has not yet been possible to find a foreign surface that has and can maintain the nonthrombogenic characteristics of the normal endothelium.