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

Thrombomodulin (TM) binds thrombin, changes thrombin conformation and allows thrombin to activate protein C and thrombin-activatable fibrinolysis inhibitor (TAFI). Activated protein C and TAFI inhibit coagulation and fibrinolysis, respectively. TM is, thus, a linker of endogenous control of coagulation and fibrinolysis. Plasma soluble TM, cleaved products of cellular TM, also have anticoagulant and antifibrinolytic properties. TM plays an important role in thromboresistance. Prospective studies show that a high plasma TM 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 of the polymorphisms are probably associated with coronary heart disease.