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min activity. This system is in turn controlled by inhibitors to tPA and plasmin-plasminogen activator inhibitor 1 (PAI-1) and alpha-2-antiplasmin. Reduced fibrinolytic activity may result in increased risk for cardiovascular events and thrombosis.

Pharmacologic activators are currently used for therapeutic thrombolysis, including streptokinase, urokinase, and tPA.

Urokinase directly activates plasminogen into plasmin, and streptokinase forms a streptokinase plas-minogen complex, which then converts plasminogen into plasmin.16

Coagulation Inhibitors

Inhibitors are soluble plasma proteins that are natural anticoagulants. They prevent the initiation of the clotting cascade. There are two major inhibitors in plasma that keep the activation of coagulation under control. These inhibitors are:

1. Protease inhibitors: inhibitors of coagulation factors, which include

• Antithrombin

• Heparin cofactor II

• Tissue factor pathway inhibitor

• Alpha-2-antiplasmin

2. The protein C pathway: inactivation of activated cofactors, which includes

• Protein C and protein S

Each will be discussed in detail in Chapter 19. Table 15.3 has a listing on inhibitor and target reaction sites.

Table 15.3

Serine Protease

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