Coagulation Problems: How does Coagulation Work?

People with coagulation problems often suffer from diseases that make it difficult for their wounds to stop bleeding.
Coagulation Problems: How does Coagulation Work?

Written by Carmen Martín

Last update: 27 May, 2022

Coagulation is the process in which the blood turns from its natural liquid state into a gel state, forming a blood clot. A clot is a mass of blood that forms when platelets, blood cells, and certain proteins stick together. Keep reading to learn about coagulation and coagulation problems that can affect your health. 

Some important notes about blood flow

First, it’s important to distinguish a blood clot from thrombus or an embolism. The word thrombus refers to a clot attached to the wall of a blood vessel. On the other hand, embolisms are clots that circulate through the bloodstream and stop in one part of the body, preventing the flow of blood.

Coagulation is an essential process for life. In fact, all mammals have a similar coagulation process. Therefore, in this article, you’ll learn valuable information about this vital anatomical process.

How does coagulation work?

To understand coagulation, it’s first necessary to understand a little bit about the physiology of blood. In its natural state, blood flows without turning into a gelatinous state. The vessel walls are healthy and there is no activation of substances that can trigger the formation of clots.

At this time, the anti-coagulation and coagulation processes are in balance. Numerous proteins work together in two different processes that help regulate this balance, or equilibrium, called hemostasis. When a vessel is damaged, a chain reaction occurs: the activation of a series of proteins leads to clot formation. This chain is called the coagulation cascade.

More than 10 different proteins, called coagulation factors, play a part in the coagulation cascade. These proteins can be found in the blood plasma.

The coagulation process

Blood cells floating in the blood vessels coagulation problems

The clotting process occurs by a chain reaction after damage to a blood vessel.

In short, the following is what happens during coagulation:

  • First, a small tear occurs in the wall of a blood vessel. This causes bleeding (the term bleeding is simply used to describe the draining of blood from the vessels, no matter how much blood is lost).
  • Then, the blood vessels constrict. This occurs in an attempt to limit blood flow and prevent too much blood from being lost due to the wound.
  • Next, the platelets become activated. Platelets are parts of cells that circulate in the blood. They adhere to each other at the wound site, forming a plug. At this time, one of the most important clotting factors starts working, knowns as the von Willebrand factor.
  • Then, the rest of the clotting factors activate the production of fibrin. Fibrin is a strong substance that makes it possible to form a kind of net that keeps the plug firm and stable.
  • When the wound heals, this plug that has formed (the clot) dissolves. Thus, balance is restored and the blood vessel returns to its natural state.

As we have already mentioned, coagulation is a fundamental process for life. When any of the elements involved in it fail, numerous diseases can occur. Thus, here are explanations of some of the most common diseases that cause coagulation problems.

Von Willebrand’s disease

Von willebrand disease coagulation problems
People with von Willebrand disease have a problem with the clotting factor.

This is the most common disorder related to coagulation problems. Additionally, people with this disease have a problem with the von Willebrand clotting factor. As aforementioned, this factor is the one that helps the platelets to clump together. It is estimated that up to 1% of the population suffers from this condition. However, the symptoms are mild and few people actually get a formal medical diagnosis.

Some of the symptoms are:

  • Nosebleeds that take a long time to stop.
  • Abundant menses in women (heavy to very heavy menstruation).
  • Excessive bleeding from an injury or blood in urine and/or feces.

Hemophilia, the most common of coagulation problems

Hemophilia is a bleeding disorder in which the person lacks factor VIII or IX. These people tend to bleed for long periods after an injury because their blood does not clot normally.

Also, it’s an inherited disease that can be very serious. When internal bleeding occurs, the organs and tissues can be damaged and put the sufferer’s life at serious risk.

Curiously, this is the disease that many members of the royal families during the 19th century suffered from. For example, the sons of the last Russian tsars suffered from this disease. Numerous studies have focused on finding the genetic origin of this disease specifically for this reason.

In conclusion

Coagulation is a complex process that keeps us alive. It’s very important to study how it works and how coagulation problems can affect health, to treat people who have a defect in it.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Smith SA, Travers RJ, Morrissey JH. How it all starts: Initiation of the clotting cascade. Crit Rev Biochem Mol Biol. 2015;50(4):326–336. doi:10.3109/10409238.2015.1050550
  • Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth. 2014;58(5):515–523. doi:10.4103/0019-5049.144643
  • Garmo C, Burns B. Physiology, Clotting Mechanism. [Updated 2019 Apr 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:
  • Chaudhry R, Babiker HM. Physiology, Coagulation Pathways. [Updated 2019 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:
  • Barmore W, Burns B. Biochemistry, Clotting Factors. [Updated 2019 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.