Thrombotic Hazard Markers: Thrombomodulin

Thrombomodulin (TM) is an active link in coagulation and hemostasis, demonstrating multimodal properties due to its unique structure. TM is expressed mainly on endothelial cells of most vessels, in gestational tissues (placenta and myometrium), in smooth muscle cells of the arteries, and in immune cells. Normally, the TM blood level in healthy individuals does not exceed 10 ng/mL, and usually increases (sometimes decreases) in various abnormal conditions. The role of TM is not limited to the activation of fibrinolysis; it also includes the regulation of inflammation and the immune response, as well as neuro- and angioprotection. The therapeutic potential of recombinant TMs in disseminated intravascular coagulation and preeclampsia is currently under active investigation. In addition, the diagnostic and prognostic value of TM as a blood biomarker across a wide range of diseases is well established. However, the diagnostic utility of TM is still limited by its relatively low specificity. Nevertheless, the experience of using TM in clinical practice indicates the potential for further study of this molecule. This review provides up-to-date information on the structure of TM, its functions, and its current use in medical practice. Also, potential prospects for further study as a marker of thrombosis risk are addressed.