One of these factors leads to turbulent blood flow which causes damage to the heart valves. The damage exposes the endothelial basement membrane which attracts platelets which form a thrombus and triggers the inflammatory process. A bacteria or other organism (which enters the blood stream from trauma, IVs, surgery, other infections, GI translocation) adheres to the endothelium and infiltrates the thrombus. This action activates the clotting cascade which accelerates fibrin formation to form the vegetation which is associated with _______________. The vegetation may form on any part of the endothelium but usually does so on the heart valves. The vegetation may break off and form an embolus and cause the formation of an abscess and is responsible for the characteristic skin changes.