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Thrombomodulin is an endothelial transmembrane protein. Its extracellular portion binds thrombin, but a small amount — referred to as soluble thrombomodulin (sTM) — is released into the circulation. Because sTM inhibits the procoagulant activity of thrombin (and the thrombin-thrombomodulin complex activates the potent natural anticoagulant, protein C), sTM might exacerbate anticoagulant-associated bleeding.
To examine this possibility, Swedish researchers measured sTM levels and assessed bleeding complications in 719 patients (mean age, 70; 37% women) who received long-term warfarin therapy. Bleeding complications that led to hospital admission or death were classified as either major (fall in hemoglobin level of ≥2 g/dL, bleeding into a cri…