Arterial Thrombus Stability: Does It Matter and Can We Detect It?

The spontaneous lysis of a coronary thrombus is a natural protective mechanism against lasting occlusion and downstream infarction. Thrombus stability is thus a direct determinant of clinical outcome. Compared with the extensive study of the crucial role of platelets, coagulation, and flow in arterial thrombosis, little attention has been paid to factors affecting thrombus stability, despite evidence linking impaired spontaneous fibrinolytic activity with acute coronary events. We summarize experimental evidence for the importance of thrombus stability and highlight the need for physiologically relevant tests to assess spontaneous disintegration/fibrinolysis of platelet-rich thrombi under arterial flow conditions, review techniques to assess thrombus stability in vitro, and describe novel imaging techniques to characterize thrombosis in vivo. Such techniques may allow tailoring of pharmacotherapy to potentiate thrombus instability, through fragmentation of platelet thrombi and/or enhanced endogenous fibrinolysis, to reduce infarct size.