Abstract

The intricate balance of haemostasis and thrombosis is fundamentally governed by enzymatic cascades, yet the efficiency and localization of these processes are critically dependent on their spatial organization at the microscale. This review addresses the pivotal role of specialized biological scaffolds in regulating the biochemical reactions of blood coagulation and fibrinolysis, moving beyond the traditional view of reactions occurring solely in the fluid phase. A primary focus is placed on the phospholipid membranes of cells and microparticles, particularly those enriched with anionic phosphatidylserine (PS), which serve as crucial platforms for the assembly of procoagulant enzyme complexes, such as the prothrombinase complex. The review synthesizes current understanding of how these membrane surfaces—derived from activated platelets, damaged endothelium, or microvesicles—provide the necessary two-dimensional environment to dramatically enhance reaction rates and ensure clot formation is localized to the site of injury. Furthermore, the manuscript explores other scaffolds, including the fibrin-extracellular matrix and polyphosphate polymers, discussing their physical meaning and physiological significance in both normal and pathological states. By detailing the mechanisms through which these microscale structures control the spatiotemporal dynamics of coagulation, this work provides a comprehensive framework for understanding complex haemostatic disorders and informs the development of targeted therapeutic strategies.