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2016 ; 23
(5
): 445-52
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Antithrombotic potential of the contact activation pathway
#MMPMID27380557
Schmaier AH
Curr Opin Hematol
2016[Sep]; 23
(5
): 445-52
PMID27380557
show ga
PURPOSE OF REVIEW: This report examines the mechanism(s) by which each protein of
the contact activation system - factor XII (FXII), high-molecular-weight
kininogen, and prekallikrein - influences thrombosis risk. RECENT FINDINGS: FXII
generates thrombin through contact activation via interaction with artificial
surfaces as on medical instruments such as indwelling catheters, mechanical
valves, stents, and ventricular assist devices. Inhibition of FXIIa-mediated
contact activation prevents thrombosis under contact activation circumstances
without affecting hemostasis. Current studies suggest that high-molecular-weight
kininogen deficiency parallels that of FXII and inhibits contact activation.
Prekallikrein inhibition contributes to thrombosis prevention by contact
activation inhibition in the nylon monofilament model of transient middle
cerebral artery occlusion. However, in arterial thrombosis models where reactive
oxygen species are generated, prekallikrein deficiency results in downregulation
of vessel wall tissue factor generation with reduced thrombin generation.
Exploiting this latter prekallikrein pathway for thrombosis risk reduction
provides a general, overall reduced tissue factor, antithrombotic pathway without
risk for bleeding. SUMMARY: These investigations indicate that the proteins of
the contact activation and kallikrein/kinin systems influence thrombosis risk by
several mechanisms and understanding of these pathway provides insight into
several novel targets to prevent thrombosis without increase in bleeding risk.