Coagulation cascade
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Coumadin inhibits: 
		II, VII, IX, X, Proteins C,S
		 [in brackets below]
	Protein C,S -> VIIIa, Va

	      (+)	  (-)
 heparin -> ATIII ->  IXa, Xa, XIa, XIIa
					thrombin
			(+)
tPA, UK, SK   -----> plasminogen
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Intrinsic {PTT}		Extrinsic {PT}

(surface contact)	(thromboplastin)
 {HMWK, PK}		 tissue factor: III
  XII -> XIIa			 	   l
	XI -> XIa				\l/	
	[IX]  ->   IXa		VIIa <- [VII]
{Ca++ VIII + vWF} \ 	  / 
			       [X]  ---->  Xa
				         l        {Va   PL 
				      \l/	 Ca++}
	 Prothrombin [II] ---> Thrombin
						/   {TM}
  Plasmin  ------> 	Fibrin  <--  I
		 (-)		    /   XIIIa
			stabilized fibrin
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vWF = vonWillenbrand factor
PL = phospholipid
HMWK = high molecular weight 
		kallikrien
PK = prekallikrien
plasma thromboplastic complement
  =  IXa, X/Xa, VIII, vWF, Ca++

VIII and IX are sex linked
Hemophilia A (VIII) and B (IX)

Liver generates all coagulation proteins except VIII

TT measures: 
	fibrin -> stabilized fibrin
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by Michael T. Milano, MD PhD
MTMilano@yahoo.com
www.geocities.com/MTMilano/palm/