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References<br />

321<br />

TABLE 10-9 Effects <strong>of</strong> Inflammation on Coagulation and Vice Versa<br />

Inflammation—Coagulation<br />

Increased fibrinogen—substrate for fibrin formation<br />

Tissue factor expression on monocytes—procoagulant<br />

surface<br />

Increased C reactive protein—promotes PAI-1 and TF<br />

formation<br />

Complement activation—increased procoagulant surface<br />

Interleukin-6—increased platelet production with increased<br />

reactivity<br />

Histamine, TNF- α , IL-8, IL-6—release <strong>of</strong> high-molecularweight<br />

vWF multimers<br />

Various inflammatory mediators—consume/inactivate<br />

antithrombin and heparin-like molecules<br />

Endotoxin, IL-1 β , TNF- α , elastase—down-regulation <strong>of</strong><br />

thrombomodulin and EPCR<br />

Coagulation—Inflammation<br />

Platelet granule release—CD40 ligand, which<br />

increases IL-6 and IL-8<br />

Tissue factor—activates PARs, which facilitates<br />

leukocyte adhesion and activation<br />

Fibrin formation—increased TNF- α , IL- β , binding <strong>of</strong><br />

neutrophils<br />

Antithrombin—decreased expression <strong>of</strong> CD11b/CD18<br />

on leukocytes<br />

Antithrombin—inhibits chemokine-induced<br />

neutrophil migration<br />

TAFI—inhibits bradykinin and C5a<br />

Thrombomodulin—inhibits leukocyte migration<br />

Activated protein C—inhibits NF- κ B in monocytes,<br />

decreased TF expression<br />

Abbreviations: EPCR, endothelial cell protein C receptor; PAR, protease activated receptor; TAFI, thrombin activatable fi brinolytic inhibitor; TF, tissue factor.<br />

the fact that inhibition <strong>of</strong> TF–FVIIa reduces inflammation<br />

in animal models <strong>of</strong> endotoxemia and in patients with sepsis<br />

( Monroe and Key, 2007 )<br />

As can be observed by looking at the mechanisms listed<br />

in Table 10-9 , if the natural anticoagulant mechanisms do not<br />

occur, promotion <strong>of</strong> inflammation takes place. Therefore, in<br />

addition to traditional anti-inflammatory therapy, treatment<br />

with anticoagulants may also reduce inflammation. Of antithrombin,<br />

TFPI, and APC, only the latter actually reduced<br />

28-day mortality in septic patients ( Bernard et al ., 2001 ).<br />

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