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Coagulation and the endothelium in acute injury in the critically ill 

Coagulation and the endothelium in acute injury in the critically ill
Coagulation and the endothelium in acute injury in the critically ill

Marcel Levi

and Tom van der Poll

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date: 21 May 2022

Vascular endothelial cells play a pivotal mediatory role in many responses to systemic inflammation, including the cross-talk between coagulation and inflammation in sepsis. Endothelial cells respond to the cytokines expressed and released by activated leukocytes, but can also release cytokines themselves. Furthermore, endothelial cells are able to express adhesion molecules and growth factors that may not only promote the inflammatory response further, but also affect a myriad of downstream responses. It has recently become clear that, in addition to these mostly indirect effects of the endothelium, injured endothelial cells directly interfere with platelet-vessel wall interactions, neutrophil entrapment through formation of extracellular nets, and activation of inflammation and coagulation mediated by microparticles. The role of the glycocalyx as an important interface between the endothelium and regulation of coagulation in inflammatory states has also gained a lot of recent attention.

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