The protein C activation system provides an interesting model for the control of coagulation. Expression of the critical receptor appears to be under the control of inflammatory mediators. Open questions of considerable importance relate to the physiological significance of these observations. Preliminary evidence is emerging that thrombomodulin is down-regulated in patients and animals with inflammation, but it remains to be determined if the loss of thrombomodulin causes the thrombotic complications or occurs in response to these complications.
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Esmon et al. (1991) studied this question.
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