Letter to the Editor

Response: Further Reflections on Virchow’s Triad

Authors: Daniel J. Brotman, MD

Abstract

I am pleased that our piece about Virchow and his eponymous triad generated such a detailed and thoughtful response. Dr. Malone agrees with our main point: Virchow did not identify stasis, hypercoagulability, and vessel wall injury as the three main precipitants of thrombosis. However, Dr. Malone is concerned that we refer to the original triad (the consequences of thrombosis) and the modern triad (the causes of thrombosis) as “one in the same.” We agree wholeheartedly that these are not (literally) the same. Our intent was to illustrate that the precipitants of thrombosis and the consequences of thrombosis are mechanistically inseparable, not to imply that Virchow, in 1856, had truly defined or anticipated the modern triad.

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References

1.Virchow R. Gesammelte Abhandlungen zur Wissenschaftlichen Medicin. [Thrombosis and Emboli, Translated by AC Matzdorff and WR Bell. 1998]. Canton, MA, Science History Publications/USA, 1856.
 
2.Brotman DJ, Deitcher SR, Lip GY, Matzdorff AC. Virchow’s triad revisited. South Med J 2004;97:213–214.
 
3.Wessler S. Thrombosis in the presence of vascular stasis. Am J Med 1962;33:648–665.
 
4.Mustard JF, Murphy EA, Roswell HC, Downie HG. Factors influencing thrombus formation in vivo. Am J Med 1962;33:621–647.