Thrombomodulin: a linker of coagulation and fibrinolysis and predictor of risk of arterial thrombosis

Thrombomodulin (TM) binds thrombin, changes thrombin conformation and allow s thrombin to activate protein C and thrombin-activatable fibrinolysis inhi bitor (TAFI). Activated protein C and TAFI inhibit coagulation and fibrinol ysis, respectively. TM is, thus, a linker of endogenous control of coagulat ion and fibrinolysis. Plasma soluble TM, cleaved products of cellular TM, a lso have anticoagulant and antifibrinolytic properties. TM plays an importa nt role in thromboresistance. Prospective studies show that a high plasma T M level is associated with a low risk of developing coronary heart disease. The plasma TM level may reflect the level of endothelial TM expression. TM expression levels are influenced by multiple gene polymorphisms. Several o f the polymorphisms are probably associated with coronary heart disease.