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Figure 1 | Critical Care

Figure 1

From: Clinical review: Clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications

Figure 1

Schematic representation of the coagulation system and sites of action of new oral anticoagulants. The coagulation response is triggered by tissue damage and exposure of components of the extracellular matrix, including collagen and tissue factor, which will activate factor VII and form a complex that triggers the activation of factors × and IX. This initiation phase will be rapidly inactivated by the tissue factor pathway inhibitor. The generation of small amounts of thrombin from prothrombin by the initial activation of factor × will in turn activate factor XI and the non-enzymatic factors VIII and V, resulting in a rapid amplification of the coagulation response with the subsequent generation of large quantities of thrombin and the subsequent conversion of fibrinogen to fibrin. The steps of the coagulation system that are affected by the new anticoagulant drugs are shown in boxes. Roman numerals indicate coagulation factors; a subindex 'a' indicates an activated coagulation factor. TF, tissue factor.

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