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From: Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution
Anesthes. 2010;113(5): doi: /ALN.0b013e3181f22b5a Figure Legend: Regulation of fibrin polymerization and fibrinolysis within the clot. The maximal thrombin generation is expected to be near the vessel wall where thrombin (IIa) generation is maximal over the highly catalytic phospholipids surface on platelets activated by collagen and tissue factor-pathway derived thrombin. Endogenous antifibrinolytics, α2-antiplasmin (α2-AP) and active thrombin-activatable fibrinolysis inhibitor (TAFIa), are also cross-linked to fibrin by thrombin-activated factor XIII (XIIIa) according to the extent of thrombin generation. Thus, fibrin near the vessel wall is highly resistant to fibrinolysis, whereas intraluminal fibrin is more accessible by tissue plasminogen activator (tPA) activation of plasminogen (Plgn) for recanalization of the injured blood vessel. Date of download: 10/14/2017 Copyright © 2017 American Society of Anesthesiologists. All rights reserved.
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