Virchow and his triad: a question of attribution

Abstract

SummaryVirchow's triad describes three factors that contribute to the development of venous thrombosis: hypercoagulability, stasis and endothelial injury. Yet, extensive review of the historical literature casts doubt on the existence of a triad described by Virchow in the form it is currently quoted throughout contemporary medical literature. Certainly his work involved extensive study of venous thrombosis and pulmonary embolism, with these two terms being coined by Virchow, but a triad of factors relating to the development of venous thrombosis is elusive. Interestingly, Virchow only began to be routinely credited with this triad one hundred years after publication of his work on venous thrombosis. This acknowledgement coincided with the accumulation of experimental evidence for the role these factors play in thrombogenesis. Controversial as the origins of Virchow's triad might be, it is apt given his substantial contribution to our knowledge of venous thromboembolism, and the fact that the triad continues to be clinically relevant today that a triad pertaining to Virchow should remain.

Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature

“…This case is unique, in that it is the only case of acute mesenteric vein thrombosis with lupus anticoagulant positive primary antiphospholipid syndrome reported so far. Venous thrombosis is due to stagnant blood flow, vascular damage and a hypercoagulable state (Virchow's triad) [8,9]. In this case report, smoking and discontinuation of warfarin in this patient with lupus anticoagulant antiphospholipid syndrome contributed to the development of superior mesenteric venous thrombosis.…”

Wirklich Virchows Trias?

“…Demnach reicht die Stase allein nicht aus für die Formation von Thromben und Virchow sah vor allem in der Hyperkoagulabilität die Ursache für die Vorgänge [4,9]. Allerdings beschrieb Virchow dieses Phänomen nicht für den Ort der Entstehung des Thrombus, sondern vielmehr als Ursache für die Adhäsion in der Lungenarterie [2,4]. Schüler waren übrigens niemand geringere als Adolf Kussmaul und Heinrich Irenaeus Quincke.…”

Mobilisation after Lower Limb Deep Vein Thrombosis and Post-Thrombotic Syndrome

“…Furthermore, it is one of the major causes for inhospital morbidity and mortality, leading to severe complications such as pulmonary embolism (PE), post-thrombotic syndrome (PTS) and even death [2]. Local damage to venous intima, venous stasis and hypercoagulability are major predisposing factors, and it is thought that two of these factors must be present for a DVT to develop [3].…”

“…Furthermore, it is one of the major causes for inhospital morbidity and mortality, leading to severe complications such as pulmonary embolism (PE), post-thrombotic syndrome (PTS) and even death [2]. Local damage to venous intima, venous stasis and hypercoagulability are major predisposing factors, and it is thought that two of these factors must be present for a DVT to develop [3].Physiotherapists frequently handle in-patients diagnosed with a DVT, and management of such patients has been controversial. For decades, conservative management of DVTs using strict immobilization was based on the theoretical assumption that early ambulation and active range of motion would cause the thrombus to dislodge proximally, migrating to the pulmonary circulation and causing a PE, possibly leading even to death [4].…”