Tissue factor pathway inhibitor in health and disease

The knowledge of tissue factor pathway inhibitor (TFPI) has greatly expanded during the last few years, and TFPI is now established as a coagulation inhibitor of great importance. Its main role seems to be inhibition of small amounts of tissue factor, which probably is essential for maintaining a normal hemostatic balance. The acceleration of TFPI's inhibitory effect by heparin, the TFPI release caused by heparin injection, and TFPI's heparin affinity may greatly contribute to the anticoagulant properties of the endothelium, and may be particularly important for the outcome of vascular injury. The information provided by one single measurement of plasma TFPI in a patient is difficult to interpret, but serial measurements during the course of a disease may signal the prognosis. Recombinant TFPI has proved effective in the treatment of experimental disseminated intravascular coagulation, sepsis, and thrombosis. Whether TFPI or TFPI derivatives will be as effective in the treatment of patients remains to be determined.