Fig. 1.

A systems biology perspective on vascular homeostasis in critical illness. Schematic illustration of the changes in the vascular system (circulating blood, vascular endothelium) with increasing disease (ischemia-reperfusion, trauma, sepsis, etc.) severity and sympathoadrenal activation (circulating catecholamines) evaluated by plasma-based (APTT, INR, PT) and functional whole blood-based (TEG) coagulation tests. Progressive endothelial activation and damage is accompanied by concurrent progressive hypocoagulability in the circulating blood. We infer (Johansson and Ostrowski) that the circulating catecholamine level dose-dependently promotes a switch from hyper- to hypocoagulability and hyperfibrinolysis in the blood to keep the progressively more procoagulant microvasculature open. From Johansson & Ostrowski [22]