Figure 2.

An imbalance between procoagulant and anticoagulant factors can promote inflammation. The excess production of tissue factor and thrombin, exposure of subendothelial collagen, and reduced levels of activated protein C that are associated with thrombus formation can lead to the activation of endothelial cells, platelets, and leukocytes. The activated cells respond to the coagulation factors by increasing the expression of adhesion molecules that facilitate their binding and interactions with other cells. Increased superoxide production (oxidative stress) and the generation/release of a variety of pro-inflammatory molecules also occur in all three cells. Some of these inflammatory products of cell activation (eg, cytokines, sCD40L, ADP, thromboxane A2, PAF) can also exert a positive feedback effect on the coagulation process, thereby creating a vicious cycle wherein inflammation intensifies coagulation and vice versa.