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Plasma prekallikrein Plasma kallikrein Coagulation factor XIIa Coagulation factor XIIa Coagulation factor XII Collagen alpha-1(I) chain Coagulation factor VII Tissue factor Tissue factor Fibrin (loose) Fibrin (loose) Fibrin (loose) Fibrin (mesh) Coagulation factor XIII A chain Coagulation factor XIIIa Coagulation factor XIII B chain Coagulation factor XIa Coagulation factor XIa Coagulation factor IX Prothrombin Coagulation factor VIII Coagulation factor V Coagulation factor VIII Coagulation factor IX Coagulation factor X Coagulation factor V Coagulation factor X Prothrombin Thrombin Fibrinogen alpha chain Fibrinogen beta chain Fibrinogen gamma chain Vitamin K epoxide reductase complex subunit 1 Vitamin K-dependent gamma- carboxylase Fibrin degradation products Plasminogen Coagulation factor X Coagulation factor VIIa Acenocoumarol Vitamin K1 2,3-epoxide Reduced Vitamin K (phylloquinone) Cortexolone Calcium Calcium Calcium Calcium Precursors of Prothrombin and coagulation factors VII, IX, ad X Prothrombin and coagulation factors VII, IX and X Calcium Cortexolone Calcium Calcium Calcium Calcium Tenase Complex Prothrombinase Complex Intrinsic Pathway Extrinsic Pathway Vascular Injury At the site of injury collagen and tissue factor are exposed to coagulation factors in the blood activating the extrinsic and intrinsic pathways. Prothrombin and coagulation factors VII, ,IX and X are transported via golgi apparatus vesicles into the blood. Extracellular Space Hepatocyte Endoplasmic Reticulum Membrane Cytosol Golgi Apparatus The fibrin mesh/clot forms at the site of vascular injury, blocking the leaking blood. Acenocoumarol is absorbed into the bloodstream through oral ingestion. Acenocoumarol works to inhibit vitamin K epoxide reductase complex subunit 1. By doing this vitamin K metabolism is inhibited thus halting the coagulation pathway from forming active clotting factors. This leads to an overall decrease in clotting in patients.