Mechanisms in Hematology: The Coagulation Cascade Aree er uke Cary Intrinsic Pathway Historically, the coagulation process has been discussed in terms of the extrinsic and intrinsic pathways. Although this description does not, accurately reflect physiological events, it has provided the framework for the evolution of current concepts: the important role of the three membrane-bound enzyme complexes. The generation of thrombin through the tissue factor pathway is insufficient to support normal hemostasis; continuation of the process depends upon thrombin activation of coagulation factors in the intrinsic pathway. Thrombin cleavage converts factor XI to Xla; in turn Xla activates factor IX to IXa, In addition, thrombin activates factors V and Vill to factors Va and Villa that function as cofactors to accelerate the reactions in which they participate. SO hone TOC 1.2345 6789 1011 1213 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 3031