Analytical Review: Hemostatic Homeostasis

Preservation of the blood fluidity is a primary prerequisite for the maintenance of the circulation and consequently of life itself. The protection against loss of this fluidity is accordingly most effective. Since blood coagulation is a sequential process involving the successive activation of multiple proenzymes^79,80 and since each activated enzyme is subject to neutralization in the plasma and cellular clearance, it must be extremely difficult to achieve a significant degree of activation of the later clotting factors in circulating blood. This interpretation of hemostatic homeostasis provides a theoretical basis for doubting blood coagulation as a continuous generalized process in vivo; it buttresses experimental evidence against the generalized coagulation hypothesis.⁸¹ Seen from a different perspective, the above concept of hemostatic homeostasis provides a teleological reason for the complexity of the coagulation process: Since so many steps are required, a great variety of independent mechanisms is available for controlling them, and there is corresponding safety in having the control mechanisms unavailable to total destruction by a single disrupting pathway.