All issues

Portal vein thrombosis (PVT) is a significant complication during both the pre-transplant and postoperative periods of liver transplantation. The multifactorial etiology of PVT, the paradoxical hemostatic state in liver cirrhosis and the limited usefulness of standard coagulation tests highlight the necessity of formalized models to assess thrombosis risk.

Objective: Using a mathematical model of the blood coagulation system, investigate the influence of hemodynamic conditions and coagulation factor levels on the likelihood of thrombus formation in the portal vein.

The portal vein is modelled as a flow-through reactor with rapid convective mixing. The mathematical model is based on Panteleev et al. (2010) detailed kinetic scheme, incorporating equations for the extrinsic pathway of coagulation activation, positive and negative feedback loops, and inhibition of active factors. The resulting system of ordinary differential equations was integrated using a one-stage Rosenbrock method with complex coefficients.

Thrombin generation was shown to exhibit threshold dependence on blood flow velocity. Above a critical velocity, the initiation phase does not transition to the amplification phase. This corresponds to physiological conditions that prevent thrombus formation. We demonstrated that, at reduced fibrinogen concentrations characteristic of hepatic dysfunction, the critical velocity threshold above which thrombus formation is suppressed increases. This indicates the system’s heightened susceptibility to stasis. Protein C deficiency had minimal effect on thrombogenesis dynamics under the modeled conditions. The modeling results qualitatively agree with clinical data on fibrinogen distribution in PVT patients ($n$ = 932, Sklifosovsky Research Institute).

In case of vessel wall damage or contact of blood plasma with a foreign surface, the chain of chemical reactions called coagulation cascade is launched that leading to the formation of a fibrin clot. A key enzyme of the coagulation cascade is thrombin, which catalyzes formation of fibrin from fibrinogen. The distribution of thrombin concentration in blood plasma determines spatio-temporal dynamics of clot formation. Contact pathway of blood coagulation triggers the production of thrombin in response to the contact with a negatively charged surface. If the concentration of thrombin generated at this stage is large enough, further production of thrombin takes place due to positive feedback loops of the coagulation cascade. As a result, thrombin propagates in plasma cleaving fibrinogen that results in the clot formation. The concentration profile and the speed of propagation of thrombin are constant and do not depend on the type of the initial activator.

Such behavior of the coagulation system is well described by the traveling wave solutions in a system of “reaction – diffusion” equations on the concentration of blood factors involved in the coagulation cascade. In this study, we carried out detailed analysis of the mathematical model describing the main reaction of the intrinsic pathway of coagulation cascade.We formulate necessary and sufficient conditions of the existence of the traveling wave solutions. For the considered model the existence of such solutions is equivalent to the existence of the wave solutions in the simplified one-equation model describing the dynamics of thrombin concentration derived under the quasi-stationary approximation.

Simplified model also allows us to obtain analytical estimate of the thrombin propagation rate in the considered model. The speed of the traveling wave for one equation is estimated using the narrow reaction zone method and piecewise linear approximation. The resulting formulas give a good approximation of the velocity of propagation of thrombin in the simplified, as well as in the original model.

Hemostasis system is one of the key body’s defense systems, which is presented in all the liquid tissues and especially important in blood. Hemostatic response is triggered as a result of the vessel injury. The interaction between specialized cells and humoral systems leads to the formation of the initial hemostatic clot, which stops bleeding. After that the slow process of clot dissolution occurs. The formation of hemostatic plug is a unique physiological process, because during several minutes the hemostatic system generates complex structures on a scale ranging from microns for microvessel injury or damaged endothelial cell-cell contacts, to centimeters for damaged systemic arteries. Hemostatic response depends on the numerous coordinated processes, which include platelet adhesion and aggregation, granule secretion, platelet shape change, modification of the chemical composition of the lipid bilayer, clot contraction, and formation of the fibrin mesh due to activation of blood coagulation cascade. Computer modeling is a powerful tool, which is used to study this complex system at different levels of organization. This includes study of intracellular signaling in platelets, modelling humoral systems of blood coagulation and fibrinolysis, and development of the multiscale models of thrombus growth. There are two key issues of the computer modeling in biology: absence of the adequate physico-mathematical description of the existing experimental data due to the complexity of the biological processes, and high computational complexity of the models, which doesn’t allow to use them to test physiologically relevant scenarios. Here we discuss some key unresolved problems in the field, as well as the current progress in experimental research of hemostasis and thrombosis. New findings lead to reevaluation of the existing concepts and development of the novel computer models. We focus on the arterial thrombosis, venous thrombosis, thrombosis in microcirculation and the problems of fibrinolysis and thrombolysis. We also briefly discuss basic types of the existing mathematical models, their computational complexity, and principal issues in simulation of thrombus growth in arteries.

The possibility of numerical 3D simulation of thrombi formation is considered.

The developed up to now detailed mathematical models describing formation of thrombi and clots include a great number of equations. Being implemented in a CFD code, the detailed mathematical models require essential computer resources for simulation of the thrombi growth in a blood flow. A reasonable alternative way is using reduced mathematical models. Two models based on the reduced mathematical model for the thrombin generation are described in the given paper.

The first model describes growth of a thrombus in a great vessel (artery). The artery flows are essentially unsteady. They are characterized by pulse waves. The blood velocity here is high compared to that in the vein tree. The reduced model for the thrombin generation and the thrombus growth in an artery is relatively simple. The processes accompanying the thrombin generation in arteries are well described by the zero-order approximation.

A vein flow is characterized lower velocity value, lower gradients, and lower shear stresses. In order to simulate the thrombin generation in veins, a more complex system of equations has to be solved. The model must allow for all the non-linear terms in the right-hand sides of the equations.

The simulation is carried out in the industrial software FlowVision.

The performed numerical investigations have shown the suitability of the reduced models for simulation of thrombin generation and thrombus growth. The calculations demonstrate formation of the recirculation zone behind a thrombus. The concentration of thrombin and the mass fraction of activated platelets are maximum here. Formation of such a zone causes slow growth of the thrombus downstream. At the upwind part of the thrombus, the concentration of activated platelets is low, and the upstream thrombus growth is negligible.

When the blood flow variation during a hart cycle is taken into account, the thrombus growth proceeds substantially slower compared to the results obtained under the assumption of constant (averaged over a hard cycle) conditions. Thrombin and activated platelets produced during diastole are quickly carried away by the blood flow during systole. Account of non-Newtonian rheology of blood noticeably affects the results.