Tobacco and Thrombosis

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Abstract
An exhaustive review of the literature is presented. Published evidence on the effect of smoking on coagulation is scanty and (partly for this reason) conflicting. The consensus is that it enhances it in vitro; in vivo studies on platelet survival reveal a shortening of their half life which reflects changes in coagulation in part, but mainly the interaction between the platelet and the vascular endothelium. The action of tobacco is largely mediated through secretion of endogenous epinephrine and this action is offset by monoamine oxidase inhibitors. No direct evidence is available bearing on the effect of smoking on thrombogenesis, but epinephrine in moderate doses promotes it while in high doses this effect is reversed. There is doubtful evidence that hypersensitivity may be involved. The need for more evidence, especially experimental, is emphasized.