A mathematical model for in vitro coagulation of blood: role of platelet count and inhibition

A mechanistic model including the role of platelets is proposed for clot formation and growth in plasma in vitro. Initiation of clot formation is by the addition of tissue factor, and initiation via the intrinsic pathway is neglected. Activation of zymogens follows the extrinsic pathway cascade and reactions on platelet membranes are included. Platelet activation occurs due to thrombin and also due to other activated platelets. Inhibition of the active clotting factors is by ATIII and TFPI, whereas inhibition due to APC is not relevant in the conditions modeled. The model predictions matched existing data for thrombin production in synthetic plasma. The model predicts that inhibition of platelet-driven activation of platelets has a major effect on concentration of activated platelets in PRP, normal plasma and PPP. Inhibition of platelet activation by (other activated) platelets significantly delays thrombin production in PRP and normal plasma as compared to that by thrombin. Further, sensitivity analysis shows that the model is most sensitive to the activation of platelet membrane-bound factor X by the intrinsic tenase complex