Current views of activating and regulatory mechanisms of blood coagulation

Coagulation factors play essential roles in not only hemostasis but also thrombosis. The coagulation reaction consists of a stepwise sequence of proteolytic reactions of the coagulation factors, and is generally divided into two pathways, a tissue factor(TF)-dependent "extrinsic pathway" and a contact factor-dependent "intrinsic pathway". The extrinsic pathway is responsible for the initiation of the clotting reaction, while the intrinsic pathway most likely amplifies it. Elevated levels of various coagulation factors such as TF, factor VIII and prothrombin have been linked to an increased thrombotic risk. To prevent thrombus formation, endothelial cells express several receptors and activators for anticoagulant factors such as antithrombin, TF-pathway inhibitor, protein C and protein S. Defects in this anticoagulant system also increase the risk of thrombosis.