I remember sitting in pathology lectures as a medical student, trying to learn the name of yet another famous Victorian physician and wishing that they had been involved in something other than the study of what causes disease. I would have liked it if Virchow’s triad referred to an acrobat troupe, but instead, as was drummed into us, it stands for three classic risk factors for clots;
- Stasis – sluggish blood movement
- Hypercoagulability – thick, sticky blood
- Endothelial injury – damage to the vessel wall
If you think about sitting in a plane for a long flight, which can be related to getting a DVT, you’ll see all three factors are met
- Sitting leads to venous stasis
- Dehydration leads to hypercoagulability
- Legs pressed against the seat could lead to endothelial damage
What I didn’t learn at medical school though was the history behind the triad:
Rudolf Virchow was born in Germany in 1821 and became a physician and political activist. He wanted medical care for the poor, a ban on child labour and social welfare programmes, so was considered rather extreme. He is famous for two major (and correct) medical suggestions; In 1856, he was the first person to suggest that pulmonary embolism was caused by a clot in the leg becoming dislodged and moving to the lung and in 1858 he suggested that the cells of the body were important in disease. Although Virchow talked about factors associated with pulmonary embolus, he never described a ‘triad’ and in fact only talked about two of the factors.
Virchow died in 1902, and it was not until the 1950s that the term “Virchow’s triad” was first used. The triad is still a useful guide today and it’s good it helps us remember Virchow, who was a great physician, even though he didn’t describe the triad named after him!
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