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The role of bronchoalveolar hemostasis in the pathogenesis of acute lung injury.
Hofstra, Jorrit-Jan H; Haitsma, Jack J; Juffermans, Nicole P; Levi, Marcel; Schultz, Marcus J.
Afiliação
  • Hofstra JJ; Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. j.j.hofstra@amc.uva.nl
Semin Thromb Hemost ; 34(5): 475-84, 2008 Jul.
Article em En | MEDLINE | ID: mdl-18956288
Disturbed alveolar fibrin turnover is intrinsic to acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and pneumonia and is important to its pathogenesis. Recent studies also suggest disturbed alveolar fibrin turnover to be a feature of ventilator-induced lung injury (VILI). The mechanisms that contribute to alveolar coagulopathy are localized tissue factor-mediated thrombin generation, impaired activity of natural coagulation inhibitors, and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. Administration of anticoagulant agents (including activated protein C, antithrombin, tissue factor-factor VIIa pathway inhibitors, and heparin) and profibrinolytic agents (including plasminogen activators) attenuate pulmonary coagulopathy. Several preclinical studies show additional anti-inflammatory effects of these therapies in ALI/ARDS and pneumonia. In this article, we review the involvement of coagulation and fibrinolysis in the pathogenesis of ALI/ARDS pneumonia and VILI and the potential of anticoagulant and profibrinolytic strategies to reverse pulmonary coagulopathy and pulmonary inflammatory responses.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Alvéolos Pulmonares / Síndrome do Desconforto Respiratório / Brônquios / Fibrina / Lesão Pulmonar Aguda / Hemostasia Tipo de estudo: Etiology_studies Limite: Humans Idioma: En Ano de publicação: 2008 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Alvéolos Pulmonares / Síndrome do Desconforto Respiratório / Brônquios / Fibrina / Lesão Pulmonar Aguda / Hemostasia Tipo de estudo: Etiology_studies Limite: Humans Idioma: En Ano de publicação: 2008 Tipo de documento: Article