PubMed · 14734041
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D S Weber, K K Griendling. 2004. Thrombin: beyond coagulation.. https://doi.org/10.1016/j.yjmcc.2003.10.009
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Cellular microparticles support coagulation by exposure of negatively charged phospholipids and sometimes tissue factor. They are involved in inflammatory processes, the transfer of membrane antigens and bioactive molecules, and in the modulation of endothelial functions. Patients with disturbances in membrane vesiculation, leading to decreased numbers of circulating microparticles, present clinically with an increased bleeding tendency. In contrast, elevated numbers of microparticles are found in a great variety of diseases involving blood-vessel damage and hypercoagulability. Microparticles are also a major component of human atherosclerotic plaques. In view of their functional properties, cellular microparticles may be a missing link between cellular and plasmatic processes underlying atherosclerotic blood-vessel damage.
Understanding of blood coagulation has evolved significantly in recent years. Both new coagulation proteins and inhibitors have been found and new interactions among previously known components of the coagulation system have been discovered. This increased knowledge has led to the development of various new diagnostic coagulation tests and promising antithrombotic and haemostatic drugs. Several such agents are currently being introduced into clinical medicine for both the treatment or prophylaxis of thromboembolic disease and for the treatment of bleeding. This review aims to elucidate these new concepts and to outline some consequences for clinical anaesthesia and perioperative medicine.