title: Carbon monoxide: Anticoagulant or procoagulant?
abstract: Within the past decade there have been several investigations attempting to define the impact of exogenous and endogenous carbon monoxide exposure on hemostasis. Critically, two bodies of literature have emerged, with carbon monoxide mediated platelet inhibition cited as a cause of in vitro human and in vitro/in vivo rodent anticoagulation. In contrast, interaction with heme groups associated with fibrinogen, α₂-antiplasmin and plasmin by carbon monoxide has resulted in enhanced coagulation and decreased fibrinolysis in vitro in human and other species, and in vivo in rabbits. Of interest, the ultrastructure of platelet rich plasma thrombi demonstrates an abnormal increase in fine fiber formation and matting that are obtained from humans exposed to carbon monoxide. Further, thrombi obtained from humans and rabbits have very similar ultrastructures, whereas mice and rats have more fine fibers and matting present. In sum, there may be species specific differences with regard to hemostatic response to carbon monoxide. Carbon monoxide may be a Janus-faced molecule, with potential to attenuate or exacerbate thrombophilic disease.
authors.affiliation: The Department of Anesthesiology, The University of Arizona College of Medicine, Tucson, AZ, USA. Electronic address: vgnielsen@email.arizona.edu.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Nielsen
authors.affiliation: The Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa.
authors.forename: Etheresia
authors.initials: E
authors.lastname: Pretorius
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000097:blood* / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects; D002248:Carbon Monoxide / Q000097:blood* / Q000494:pharmacology*; D003029:Coagulants / Q000097:blood* / Q000494:pharmacology*; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans
chemical_list: D000925:Anticoagulants; D003029:Coagulants; D002248:Carbon Monoxide; D005340:Fibrinogen
keywords: Carbon monoxide; Coagulation; Fibrinogen; Fibrinolysis; Platelet