Thrombin-Antithrombin System

摘要: Antithrombin (AT) is the most abundant and important physiological anticoagulant in body [1]. AT deficiency animal results embryonic death, mutations that reduce levels result severe thrombotic conditions. For example, AT-deficient fish exhibited consumptive coagulopathy or disseminated intravascular coagulation (DIC) following injury [2]. It generally accepted thrombin produced as a of activation innate immune system after injury, natural anticoagulants play role preventing accidental clot formation. Since ancient times massive blood loss from trauma has been frequent life-threatening event encountered by humans. As result, heavy-duty evolved to promote hemostasis setting injury. In face this thrombogenic tendency, impairment mechanisms can easily induce problematic events critical situations, including [3]. dysregulated over-activation tends occur under such circumstances. The disorder represented microvascular thrombi contribute decreased oxygen delivery subsequent organ dysfunction. Accordingly, therapy expected some alleviating dangerous [4]. Large-scale randomized controlled trials (RCTs) examine effects therapies were conducted early 2000s, predominantly focused on sepsis [5–7], but none agents examined demonstrated clear beneficial effect. no currently approved for clinical use treatment DIC. However, have suggested sepsis-associated DIC, not itself, could benefit therapies. Some subgroup analyses performed among subjects with DIC aforementioned revealed trends toward favorable activated protein C mortality [8, 9]. Recently, small, well-designed RCT succeeded demonstrating efficacy dose obtaining resolution septic patients [10]. addition, recombinant thrombomodulin also shown trend [11]. Analyses using nationwide administrative database Japan positive supplementation [12, 13]. there still concrete evidence trauma-induced (TIC). part chapter, structure, unique characteristics naturally derived anticoagulant, theoretical background systemic disorders are introduced.