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Haemostasis
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Secondary haemostasis consists of a cascade of coagulation enzymes (serine proteases) that results in the conversion of soluble fibrinogen to insoluble fibrin by thrombin resulting in a cross-linked fibrin mesh at the site of injury. In healthy and intact blood vessels, this cascade is not activated and is inhibited by several anticoagulants such as thrombomodulin and heparan sulphate. Thrombomodulin is a co-factor for thrombin that converts it from a procoagulant to anticoagulant by activating protein C. Heparin sulphate stimulates the activation of antithrombin, which inactivates thrombin and factor Xa.
Endothelial cell dysfunction and pre-eclampsia
Published in Pankaj Desai, Pre-eclampsia, 2020
Many markers have been identified in experimental and clinical investigations, which are supposed to indicate the endothelial activation process. They have been reported in pre-eclampsia and include: Increased circulating concentration of endothelin-1.5Increased levels of fibronectin in circulation.6Decreased levels of circulating vasodilator PGI2.7Altered levels of circulating thrombomodulin.8
Pregnancy-Related Proteins Detected by Their Biological Activities
Published in Gábor N. Than, Hans Bohn, Dénes G. Szabó, Advances in Pregnancy-Related Protein Research, 2020
Thrombomodulin is a newly recognized anticoagulant. It forms a 1:1 stoichiometric complex with thrombin. In this complex, thrombin fails to react with its natural substrates including fibrinogen, factor V, and platelets, while the ability of thrombin to activate protein C is enhanced more than 1000-fold.145,146 Activated protein C functions as a potent anticoagulant by inactivating coagulation factors Va and VIIIa. Thus, thrombomodulin functions to convert thrombin from a procoagulant protease to an anticoagulant.
Plasma thrombomodulin levels are associated with acute kidney injury in patients with acute heart failure
Published in Annals of Medicine, 2022
Shu-Min Lin, Chih-Hsiang Chang, Ting-Yu Lin, Allen Chung-Cheng Huang, Chiung-Hung Lin, Yung-Chang Chen, Pao-Hsien Chu
The complex pathophysiology of CRS type 1 has yet to be fully elucidated. Recent evidence suggests that endothelial activation/injury are involved in pathogenesis of CRS I [6]. Endothelial injury may cause decreased glomerular filtration rates and impaired diuretic efficacy. These effects subsequently result in fluid retention and venous congestion, therefore, the cardiac output and renal perfusion are depressed [7]. Thrombomodulin (TM) and angiopoietins (Ang) play important roles in the process of endothelial activation and injury [8,9]. TM, a membrane-bound glycoprotein predominantly expressed in endothelial cells, has been shown to neutralize the clotting activity of thrombin and activate the anti-coagulant and anti-inflammatory properties of protein C [10]. A circulating soluble form of TM (sTM) is also released into the plasma through proteolytic degradation. The fact that sTM is released from the surfaces of endothelial cells only after injury makes it a recognizable marker of endothelial injury [11]. One previous study reported elevated sTM levels in patients with acute heart failure but not in those with chronic heart failure [12]. Researchers have also reported that elevated sTM plasma levels are associated with kidney injury following sepsis [8] and acute myocardial infarction [13].
Disseminated intravascular coagulation in children with cancer: A systematic review
Published in Pediatric Hematology and Oncology, 2020
Christine Kongstad, Torben Stamm Mikkelsen, Anne-Mette Hvas
Notably, we found anticoagulant treatment with unfractionated heparin to be the most frequently administrated supportive agent in pediatric acute leukemia27,29,30,36,37,39 and solid tumors.41,42,45 When reported, heparin was administrated in prophylactic doses.27,29,30,36,39,41 Nevertheless, the use of anticoagulant treatment with heparin seems contradictory in this setting since the majority of children died due to hemorrhages. However, the fact that the articles in which unfractionated heparin was administrated are almost 30 years old must be kept in mind, because they most likely do not represent current best practice. A new anticoagulant agent, recombinant thrombomodulin, has been authorized for use in both adults and children with DIC in Japan since 2008 (38). The usefulness of recombinant thrombomodulin in DIC treatment was evaluated in Yagasaki et al, with the conclusion that the efficacy could not be assessed due to a small heterogeneous patient cohort and the lack of age- and disease-matched controls.38 Thus, the use of recombinant thrombomodulin needs further investigation.
Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF): an overview of current and future therapeutic strategies
Published in Expert Review of Respiratory Medicine, 2020
Davide Biondini, Elisabetta Balestro, Nicola Sverzellati, Elisabetta Cocconcelli, Nicol Bernardinello, Christopher J. Ryerson, Paolo Spagnolo
Thrombomodulin (TM) is a transmembrane glycoprotein expressed mainly on the surface of endothelial cells that exerts antinflammatory, anticoagulant, and anti-fibrinolytic properties [67]. Based on the hypothesis that altered coagulation and fibrinolysis contribute to the pathogenesis of AE-IPF, a number of mostly retrospective studies have assessed the efficacy of recombinant human soluble TM (rhTM) in this setting. Tsushima and colleagues compared the outcome of 20 AE-IPF patients treated with rhTM 0.06 mg/kg/day for 6 days added to methylprednisolone with that of six historical patients treated with pulse methylprednisolone alone who served as controls [68]. The 28-day survival was significantly higher in the rhTM group (65% vs. 17%, respectively; p = 0.048), and rhTM treatment was also associated with improved SpO2/FiO2 ratio. Similarly, two retrospective studies reported a 90-day survival of almost 90% among AE-IPF patients treated with rhTM, but in both studies most patients received also cyclosporine A [69,70]. More recently, Sakamoto and colleagues reported on a retrospective study of 80 patients with AE-IPF, 45 of whom had been treated with rhTM [71]. Compared with patients who did not receive rhTM (control group), those treated with rhTM had a significantly higher 3-month survival (37.1% vs. 66.6%; p = 0.003); overall survival was also significantly better in the rhTM group than in the control group (p = 0.003).