Fig. 3

Endothelial molecular pathogenesis and microthrombogenesis in sepsis. (Based on “two-activation theory of the endothelium”). (Reproduced and modified from Thrombosis Journal 2018;16:20). Endothelial molecular pathogenesis is succinctly illustrated. Endotheliopathy activates two main pathways. Activation of inflammatory pathway produces cytokines, which main function is the modulation of inflammation, including fever and myalgia. Activation of microthrombotic pathway causes much more deadly septic syndromes via generalized EA-VMTD/DIT. Abbreviations: CNSD central nervous system dysfunction, DIC disseminated intravascular coagulation, DIT disseminated intravascular microthrombosis, EA-VMTD endotheliopathy-associated VMTD, FHF fulminant hepatic failure, MAHA microangiopathic hemolytic anemia, SIRS systemic inflammatory response syndrome, TCIP thrombocytopenia in critically ill patients, TTP thrombotic thrombocytopenic purpura, ULVWF unusually large von Willebrand factor multimers, * cell-mediated immune cells are T lymphocyte, macrophage, monocyte, neutrophil, and dendritic cell