REVIEW ARTICLE Plant‑based diets and thrombotic risk factors 1 Randomized control trials and observation‑ al studies have identifed a number of pathways through which plant‑based diets can improve car‑ diometabolic health. Tese include a number of risk factors recognized by the European Society of Cardiology guidelines for CVD prevention 9 : re‑ duction of obesity and its downstream sequelae, improved glycemic control and decreased insulin resistance, decreased blood pressure, and an im‑ proved lipid profle (reviewed by Kahleova et al 10 ). In addition, plant‑based diets have been shown to improve other CVD‑related pathways such as cessation and reversal of atherosclerotic plaque deposition, decreased infammation and throm‑ bosis. Tere is a vast amount of literature inves‑ tigating the relationship of diet with thrombosis, but most of these studies assessed the efect of individual nutrients or foods such as alcohol, di‑ etary fat, n‑3 fatty acid supplementation, fber, carbohydrates, and a variety of micronutrients Introduction Plant‑based diets primarily con‑ tain foods of plant origin, which include not only vegetables and fruit, but also nuts and seeds, le‑ gumes and beans, oils, and whole grains. Plant‑ ‑based diets do not necessarily exclude all animal products and can range from total exclusion (eg, vegan) to meat consumption once to twice a week (eg, fexitarian). Te unifying focus is on the con‑ sumption of more foods from plant sources pro‑ portional to animal‑based foods. 1 Consumption of plant‑based diets have been associated with a signifcant reduction in car‑ diovascular disease (CVD) risk, 2-4 CVD mortal‑ ity, 5,6 and also all‑cause mortality. 7,8 Te benef‑ cial efect of plant‑based diets on cardiometabol‑ ic health has been attributed to, amongst others, the low caloric density, lower saturated fat, and higher mono‑ and polyunsaturated fat content, high fber content as well as its antioxidant and anti‑infammatory compounds. 1 REVIEW ARTICLE Te efect of plant‑based diets on thrombotic risk factors Marlien Pieters 1,2 , Albe C. Swanepoel 1 1 Center of Excellence for Nutrition, North‑West University, Potchefstroom, South Africa 2 Medical Research Council Unit for Hypertension and Cardiovascular Disease, North‑West University, Potchefstroom, South Africa Correspondence to: Marlien Pieters, PhD, Center of Excellence for Nutrition, North‑ ‑West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa, phone: +27 18 299 2462, email: marlien.pieters@nwu.ac.za Received: September 15, 2021. Revision accepted: September 27, 2021. Published online: October 27, 2021. Pol Arch Intern Med. 2021; 131 (10): 16123 doi:10.20452/pamw.16123 Copyright by the Author(s), 2021 KEy WoRds coagulation, dietary patterns, plant‑based, thrombosis, vegetarian AbsTRACT Plant‑based diets are considered to improve cardiometabolic health and to protect against cardiovascu‑ lar disease. Although they center around plant‑based foods, they do not necessarily exclude all animal products and comprise of a range of intakes that vary according to the type and the proportion of animal products included. Numerous metabolic pathways have been identified through which plant‑based diets can exert beneficial effects including improved body composition, lipid profile, and glucose metabolism and decreased inflammation and blood pressure. Their effects on thrombosis as a cardiovascular disease pathway are, however, less clear. Ample evidence for the effects of individual dietary components of plant‑based diets on thrombotic risk factors exists, but the effect of whole diets and / or dietary pat‑ terns remains less‑well explored with the existing literature reporting inconsistent and inconclusive findings. Here we aim to review the literature describing the effect of different plant‑based diets (vegan, lacto‑vegetarian, lacto‑ovo‑vegetarian, pescatarian, and flexitarian) and dietary patterns (Mediterra‑ nean, Nordic, Portfolio, and DASH) on specific thrombotic risk factors (fibrinogen, platelets, factor VII, fibrinolysis) in order to better clarify these relationships and to try to explain the apparent discrepant findings. We demonstrate that a one‑size‑fits‑all conclusion cannot be drawn and that the potential antithrombotic effect of different plant‑based diets depends on the nutrient composition, the content of active antithrombotic dietary components, the relative absence of prothrombotic dietary factors as well as the degree of total caloric restriction.