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LMWHs reduce angiogenesis/tumor vasculature. LMWHs directly cause the release of TFPI from endothelial cells. TFPI inhibits the TF and activated factor VII (TF–FVIIa) complex, resulting in reduced protease-activated receptor 2 (PAR-2) activation and the elimination of angiogenic signaling. TFPI also inhibits a variety of proangiogenic factors, while interacting with thrombospondin-1 (TSP-1) causes an increase in endothelial cell apoptosis.
