Biofilm formation on intravascular implants and devices and its role in coagulation and inflammation. The illustration shows how biofilms form on intravascular implants and devices, and how they can trigger blood clotting and inflammation. (1) Planktonic bacteria: planktonic bacteria move to the surface of the implant. (2) Initial adhesion: bacteria attach to the implant surface, starting the colonization process. (3) Microcolony formation: the attached bacteria start to grow and form small clusters, producing a protective slime. (4) Biofilm maturation: the biofilm develops into a structured, organized colony with a matrix composed of polysaccharides, extracellular DNA, LPS, or LTA, and PGN. (5) Biofilm dispersion: bacteria and matrix fragments are released from the biofilm, dispersing into the bloodstream and potentially inducing new infections. Released bacterial molecules, including LPS, LTA, and PGN, are capable of activating FXII, starting the blood clotting process. At the same time, bacterial fragments can trigger inflammation, creating a high-risk environment for thrombosis and immune reactions around the implant. ECMO, extracorporeal membrane oxygenation; PolyP, polyphosphates; TAVR, transcatheter aortic valve replacement.