Figure 4.

Endothelium and coagulation cascade in sepsis. When endothelial integrity is compromised by membrane attack complexes and endothelial apoptosis, a prothrombotic state ensues: endothelial cells express adhesion molecules and platelets become activated. Activated platelets release a number of active compounds contributing to the inflammatory cascade. Bacterial components, ROS, and cytokines lead to acquired ADAMTS13 deficiency and accumulation of vWF multimers that are secreted from the activated endothelium. Activated endothelium also secretes PAI-1, further contributing to a prothrombotic state (see text for details).