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Fig. 1. Stages in the development of a platelet thrombus on collagen exposed at sites of injury. The initial interaction of platelets with subendothelial collagens under high shear conditions present in the arterial circulation is indirectly mediated by von Willebrand factor, which binds collagen and platelet GPIb. This unstable interaction facilitates transient tethering and rolling. GPIb-mediated adhesion is superseded by more-stable binding to collagen by GPVI and integrin
2ß1. This, together with GPIb, stimulates platelet signalling that results in shape change and spreading, and the secretion and release of multiple prothrombotic factors. Integrin affinity becomes upregulated through inside-out signalling, resulting in fibrinogen-mediated platelet aggregation through binding to integrin
IIbß3, and adhesion is stabilized by enhanced binding of collagen and von Willebrand factor to integrins
2ß1 and
IIbß3, respectively.