Figure 2.

Effects of chemotherapy on coagulation activation. Chemotherapy may cause incongruous activation of hemostasis through various mechanisms: direct endothelial cell toxicity and apoptosis; vascular cell activation, resulting in tissue factor (TF) exposure; production of reactive oxygen species (ROS); unbalance of factors involved in the control of the coagulation cascade, with an impairment of the protein C (PC)/protein S (PS) anticoagulant pathway; activation of the monocyte/macrophage system and platelets. aPC: activated Protein C; (O₂^•−): superoxide anion; (OH^•): radical hydroxyl radical; (NO^•): nitric oxide; TF: tissue factor.