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November 22, 1965


JAMA. 1965;194(8):906. doi:10.1001/jama.1965.03090210070022

Coronary occlusion is generally the result of two distinct, but often coincident, processes: the first, atherosclerosis, produces a slowly progressive narrowing of the artery; the second, thrombosis, often causes a sudden complete obstruction of the lumen. Inasmuch as the occluding thrombus is generally at or near the site of greatest narrowing, the thrombus is usually considered a complication of local factors such as intimal ulceration or intimal hemorrhage. This concept does not exclude the possibility that thrombosis may also be the result of an increased tendency of the blood to clot, ie, a circulating or hematogenous factor. However, the importance of circulating thrombogenic factors is disputed, and attempts to demonstrate increased coagulability of the blood in patients with ischemic heart disease are inconclusive. A fundamental criticism of such studies is that most coagulation tests are concerned with some stage in the formation of fibrin, whereas thrombosis is initiated primarily by

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