Pulmonary Embolism and vascular injury: What is the role of thrombin?

Lungs possess dynamic and complex coagulation-thrombolytic and inflammatory sets of innate reactive responses,which generate changes that cause a dramatic alteration in its parenchyma. clinically, since its steps are reciprocallyinter-connected, the pulmonary embolic injury is very complex to describe as one exclusive progression. for example,each step in a coagulation-fibrinolytic-inflammation-integrated pathway produces more side-steps, which later plays animportant role in a specific lung damage description. in this clinical review, the enzyme thrombin, an ontogeneticallyvery old and key blood coagulation serine protease is centrally placed as a mediator, activator and up-regulator of postpulmonaryembolic damage to reveal its enormous flexibility in post-pulmonary embolism damage and its reparativeprocesses. additionally, some beneficial aspects of its control throughout its inhibition are discussed.abbreviations: adp adenosine 5 diphosphate; apc activated protein c; aptt activated partial thromboplastin time;asa acetylsalicylic acid; at iii antithrombin; c-iinh c-linhibitor; ec endothelial cells; enos endothelial nitricoxide synthase; epcr endothelial protein c receptor; fdp's fibrin degradation products; fibrin stabilization factor fsf;fm fibrin monomer; gag glycosaminoglycans; gp glycoprotein; hc ii heparin cofactor ii; hit heparin inducedthrombocytopenia; hmwk high molecular weight kininogen; lduh low dose unfractionated heparin; lmwh lowmolecular weight heparin (s); lv left ventricle ; map mean arterial pressure ; mlck myosin light chain kinase; nonitric oxide; pa pulmonary artery; pars proteinase (or protease)-activated receptors; pc protein c; pai-l plasminogenactivator inhibitor; pe pulmonary embolism; pf 4 platelet factor 4; pla-2 phospholipase a 2; pn-i protease nexin;pt prothrombin time; rbc red blood cell ; rv right ventricle; smc's' s vascular smooth muscle cells ; t-pa tissueplasminogen activator; tafi thrombin activatable fibrinolysis inhibitor; tf tissue factor (factor iii); tfpi tissue factorpathway inhibitor; tm thrombomodulin; tnf tumor necrosis factor; txa 2 thromboxane a2; vegf vascular endothelialgrowth factor ; vwfvon willebrand factor.