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Coagulation cascade memorization

Discussion in 'Step I' started by BlondeCookie, Nov 27, 2006.

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  1. BlondeCookie

    BlondeCookie Senior Member 7+ Year Member

    Jul 4, 2005
    I'm having a hard time memorizing the steps of the coagulation cascade. Is there a mnemonic or some sort of easy way people are using to memorize all the intrinsic, extrinsic, and common pathways?
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  3. trudub

    trudub Senior Member 7+ Year Member

    Oct 23, 2003
    I don't think there is. I think you just have to draw out a diagram over and over and try to turn it into a story. What parts of it are you specifically having trouble remembering, I mean are you having trouble remembering what activates what or which require calcium or what?
  4. BlondeCookie

    BlondeCookie Senior Member 7+ Year Member

    Jul 4, 2005

    Yes, I am having trouble remembering what activates what, but also having some trouble remembering what each factor is. For example, Factor I = Fibrinogen, Facter II = Prothrombin, Factor III = Tissue Thromboplastin, etc. And another thing, some texts have simpified steps of the extrinsic, intrinsic, and common pathways. While other texts are more comprehensive. So, it's a bit confusing getting it all straight.

    A couple of specific questions.
    1) Both the intrinsic & extrinsic pathway are occuring at the same time correct? For example, a trauma such as a paper cut would set off both pathways simultaneously, right? :confused:
    2) Is the coagulation cascade (ie intrisic, extrinsic, common pathways) a part of primary hemostasis or secondary hemostasis?
  5. YouDontKnowJack

    YouDontKnowJack I no something you don't 5+ Year Member

    Apr 21, 2005
    simplify by ditching the roman numerals, and using alphanumerics instead
  6. UCLAstudent

    UCLAstudent I'm a luck dragon! 10+ Year Member

    Sep 6, 2002
    1) Yes, they both occur at the same time. However, the designations of "intrinsic" and "extrinsic" pathway are only really useful in a laboratory setting (i.e., determining PTT or PT). In vivo, the two pathways likely interact with each other extensively (for example, 7 can activate 10).
    2) Secondary hemostasis. Primary hemostasis refers to the formation of the platelet plug
  7. BlondeCookie

    BlondeCookie Senior Member 7+ Year Member

    Jul 4, 2005

    Very nice explanation. Much thanks UCLAstudent and everyone else! I've got this one down good now.
  8. Buckeye(OH)

    Buckeye(OH) 5K+ Member 10+ Year Member

    Mar 28, 2004
    Toledo, Ohio
    Also don't forget that fibrinolysis is getting fired up at about the same time that the coagulation cascade is being fired up. Its typically taught as sequential, but that isn't entirely true.
  9. flipgirl12

    flipgirl12 New Member

    Apr 30, 2006
    One thing I use is this mnemonic: picturing a woman crying over a break up, talking about her ex (extrinsic pathway), and how he was a professional hockey player (the number 7 turned upside down looks like a hockey stick). The whole time she is crying, so she is using a tissue (factor). But before her boyfriend played hockey, he also played baseball (10 looks like a bat and a baseball) and golf (9 looks like a golf club).
  10. Buckeye(OH)

    Buckeye(OH) 5K+ Member 10+ Year Member

    Mar 28, 2004
    Toledo, Ohio
    Lord, thats too much work.
  11. flipgirl12

    flipgirl12 New Member

    Apr 30, 2006
  12. viostorm

    viostorm Senior Member 10+ Year Member

    Feb 3, 2005
    Someone in our class had this pneumonic for intrinsic.

    Factor Eleven (ends in n) goes to Factor Nine (begins with n, ends in e) which by the action Factor Eight (begins in E, ends in T) in the presence of Calcium, converts Factor Ten to Ten-a (begins with T)

    Also, everything with "a" is active. Without a, inactive.

    Someone should send that in to FA.
  13. Jon Davis

    Jon Davis I killed the bank. 10+ Year Member

    Nov 14, 2000
    In your consciousness.
    RnaPolymerase2 likes this.
  14. peter90036

    peter90036 not out fishing 7+ Year Member

    Jul 13, 2005
    next to the pond
    lordy lordy many years reading the same ol stuff, still cant hold it in ....

    couple hours later & caffeine crashed, this i still remember from my mnemonic (which i devised today...the previous one seems to have been erased from the brain)

    1 ex 7 (forgot what the 1 was for...maybe i was thinking 1 factor...)
    ex warf (wife - warf) ex warf (from warfarin has a role in here)

    12 in ptt + 3 (sing it)
    3 for 3 more factors (11,9,8)
    3 for ptt has 3 letters :O
    in = intrinsic

    ...hopefully i remember 12 in ptt so then the other one - pt is ex 7

    the final = 10 5 2 1 (you know... math... )

    two - thrombin

    1 ...f1br1nogen
    Last edited: Aug 16, 2008
  15. The actual name of the factors you can remember as follows:

    "Foolish People Try Climbing Long Slopes After Christmas Some People Have Fallen "

    I have always found it helpful.
    As far as the cascade goes if you draw it out a bunch of times you won't have any problem remembering it. :)
  16. UditNarayan

    UditNarayan 2+ Year Member

    Jul 16, 2008
    if anyone's a visual learner, try to stick to using only one image of the cascade - i chose goljan's picture in his rapid review book. I kept referring to it when I forgot a component of the picture, and by the end, I could draw it out for you. if you're visual, keeping things simple will reduce the number of images you'll need to recall. that worked for me, good luck!
  17. Twitch

    Twitch 7+ Year Member

    Jun 17, 2004
    For the common pathway, just think of dollar denominations:


    W ex PT : Warfarin; Extrinsic Pathway; only one coag factor 7

    Rest in aPTT; Heparin (12,11,9,8)

    Transposony likes this.
  18. scpod

    scpod Moderator Emeritus 10+ Year Member

    Oct 13, 2005
    These are notes from our board review that I've attached. So, it might be a little hard to understand. But, we sat there in review and drew it out a few times and everyone in my class pretty much mastered it. Hope you understand the notes.

    Attached Files:

  19. absolutjag9

    absolutjag9 7+ Year Member

    Feb 17, 2009
    thanks for the notes! :) those helped!
  20. kryptik

    kryptik 2+ Year Member

    Apr 12, 2008
    very nice notes scpod, was having similar problems as the OP and your notes helped a ton! If you have similar notes for other concepts please do share :)
  21. perilou

    perilou 2+ Year Member

    Oct 5, 2007
    I know this is a back-from-the-dead thread, but WOW! These notes are amazing.
  22. fatdoctor

    fatdoctor November

    Mar 8, 2007
    Last edited: Jun 22, 2010
  23. sendwich

    sendwich you rock! 10+ Year Member

    May 2, 2002
    how does heparin work? anyone have a succint answer for that? I know that it works in the intrinsic pathway (measured by PTT) and it works with AntiThrombin III to inactivated Factor 5 and 8?
  24. rahulb

    rahulb nutritional facelift 2+ Year Member

    Mar 17, 2007

    heparin binds and accelerates the action of antithrombin III -> degradation of activated clotting factors (thrombin)
  25. scube

    scube 2+ Year Member

    start with extrinsic pathway. sounds like exercise, PT (physical training) which you should probably do 7 days a week. Also must be outside of you coming in like a knife so what will help things out tissue factor. Who does a lot of PT, the military so they are prepared to go to WARfarin.

    INtrensic factor well its the other one, so PTT/heprin. I just remember its the ones around 10 but not 10 in decending order. 12-11-9-8.

    both of them converge at 10 which is how i remember which one is skipped in intrensic pathway. you just have to remember this part although the money example above is sweet so in available bills. 10-5-2-1

    SOme notes. PTT/PT are elevated with use of either anticoag. if you look at the pathway it makes sense to use the ones they use as a judge for the effecacy bc it includes the right blocked factors(makes most sense for warfarin). Von WIllibrans doesn't really play a part in clotting but you can see a variation bc it increases the half life of 8, so you have a defacto 8 def. so PTT is elevated(it is one of the ones around 10 right.)

    I have a minilecture I do on this but cant do as well writing it out. I hope someone takes something away from this. If you have questions ask, if you have an example to improve my lecture post it(the money one is great). I learned this because a Prof. that I hate said it is impossible and pointless to memorize the 3Cs of medicine(krebs,coag,complement) i memorized the first two and it has served me well, even on what i suspect are his questions.
  26. scube

    scube 2+ Year Member

    it breaks down the following, 9,10,11,12,and 2. which are all in the full intrinsic pathway(intrinsic plus common) which is why using PTT is a better judge of heparin function.

    warfarin, 10, 9, 2, 7. it has seven so bingo it will affect extrinsic pathway more.

    Also both drugs raise both PT, PTT. they both have at least one factor in the common pathway so it must affect both.
  27. DoctorMedic

    DoctorMedic 7+ Year Member

    May 31, 2009
    bump...that cheat sheet is amazing!
  28. drc243

    drc243 New Member 2+ Year Member

    Apr 23, 2006
    I took my boards today and that cheat sheet which i learned lived from dr barone got me atleast four questions right and each question took me all of 30 seconds.
  29. braluk

    braluk SDN Surgerynator Moderator Emeritus 5+ Year Member

    Apr 30, 2006
    The Big Easy
    SDN Author
    The way I memorized it was:

    12....11.....9.....8 (skip 10)

    Extrinsic: (I went to War (warfarin check with PT) with my "Ex", who is a "Physical Therapist" (PT)- Of course, Intrinsic are the other choices[PTT/Hep])


    Both converge onto 10 (common pathway begins here). Next is 5. 10 divided by 5 is 2 (Thrombin= which also goes back and activates more 5). 2 cut in half is 1, finishing off with Fibrin (13 activates- u'll just have to memorize that).

    This is kind of silly but in Asian culture, the number 8 is lucky, like winning a Volkswagen (VW) in "A" contest. (VW stabilizes 8, and "A" being hemophilia A, with B the one right after it (9)).

    I guess making up your own little stories will be the best.
  30. hferdjal

    hferdjal 2+ Year Member

    Jul 30, 2007
    Holy ****ing ****, those notes are amazing. I'm going to e-mail it to all my friends. And yes, I know. Crypt-posting. But seriously, these notes are that good to justify it IMO.
  31. Captopril

    Captopril 7+ Year Member

    May 10, 2008
    The ICU
    is our generation seriously too ADD to freaking memorize a simple flow chart? just draw it like 10x and it's in the memory banks. no need to sing songs or hit up random obscure notes
  32. lovepath11


    Nov 17, 2009
    :thumbup:Barone Rocks:)......

  33. crazymedstudent


    Jan 13, 2010
    Factor ate starts with A, so it goes with hemophilia A. Missing Factor 9 would turn your world upside down (9 looks like an upside down B for Hemophilia B).
  34. sswang00

    sswang00 MS4 2+ Year Member

    Feb 20, 2010
    Just wanted to bump this up, because that cheat sheet is amazing!

    Other little facts that help me remember this:
    -"PET": PT = extrinsic (includes all the common factors and Factor 7)
    ="PITT": PITT = intrinsic (includes all factors except 7, 13)

    How to remember the factors involved in both: 1 x 2 x 5 = 10 (Factors 1,2,5,10)
    Transposony likes this.
  35. end stage fibro

    end stage fibro die lauded Lifetime Donor 10+ Year Member

    Feb 12, 2005
    if you ever need anything ever in life let me know and i will do my best to do it for you.


  36. MoscowAbe

    MoscowAbe 5+ Year Member

    Apr 30, 2010
    The easiest thing for me was to use the diagram in FA in such a way that I drew a wall/line to separate the extrinsic from the intrinsic pathway. Than I placed all the relative info pertaining to each pathwy on the respective side of the wall.
  37. premedc


    Jul 19, 2008
    One of the most awesome guides I had ever read. For as long as I can remember I could not figure out a way to organize the stupid coag cascade. Your doc made its memorization seamless. WOW!!!!

    Thanks a bundle.
  38. bruinhd

    bruinhd 2+ Year Member

    May 20, 2008
    THIS. Awesome advice. I have been doing this forever.
  39. ktn699


    Jun 30, 2011
    The Windy City
    12? no, 11.98. i'm intrinsically a cheapskate...

    the rest should be bruteforceable.
    Th2, Transposony and Avicenna like this.
  40. VeryImportant


    Dec 31, 2011
    I found a good video on Youtube if you search Easy Coagulation Cascade. It's just a guy talking while he draws it out.

  41. Avicenna

    Avicenna Banned Banned Gold Donor 2+ Year Member

    Nov 18, 2012
    love it
  42. LeonTheLyon


    Jul 16, 2015
    These notes are golden! Thank you so much Scpod.
  43. phonyreal98

    phonyreal98 7+ Year Member

    Apr 19, 2008
    Watch the pathoma video on coagulation. If you don't have pathoma, find someone who does, and ask to watch it with them.
  44. Khorreed


    Jul 11, 2015
    OMG dont even try to MEMORIZE this, because you ll have further problems with drugs
    Pathoma 4th section, dr. Sattar explaining for idiots(you can find his videos by kickingass.to someone if you dont want to pay for it yet, I definetely recommend you to watch his videos first for free, and if you d like it then to buy

    a is active form
    without a - is procoagulants(inactevated, floating in plasma all the time)

    e.g. factor 1 is fibrinogen
    Factor 1a is fibrin

    First we need to get to factor 10
    Intrinsic 12 11 skip 10(because we need to get to 10)- 9- 8
    Extrinsic - 7
    After we get to 10 we need to get to 1
    10 - 5 - 2 - 1

    1 * 2= 2

    And we get to fibrin
    And yes, learning coag cascade with drugs is mandatory

    Attached Files:

  45. Khorreed


    Jul 11, 2015
    Top kek, who tells you to learn that way?:D Is it even helpful?
  46. Transposony

    Transposony Do or do not, There is no try 5+ Year Member

    Nov 10, 2011
    It is helpful for someone who had series of breakups with hockey, baseball and golf players.
  47. aspiringmd1015

    aspiringmd1015 2+ Year Member

    Mar 5, 2014
    lmao, snide remarks like this make my study breaks that much better

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