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Marcel Levi, MD; Sander J.H. van Deventer, MD
Academic Medical Center Amsterdam, the Netherlands

JAMA. 1994;271(6):428.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—The observation of Logan et al supports the notion that the induction of fibrinolysis and coagulation by cytokines follows different pathways. Endotoxin as well as TNF causes t-PA release in vivo, before thrombin generation can be detected, and neutralization of TNF in endotoxemia inhibits t-PA release, but not thrombin formation. The temporal relationship between neutropenia and t-PA release that occurs in TNF-infused cancer patients was also observed in healthy volunteers who received a bolus TNF injection and may indicate a causal role of activated adhering neutrophils for t-PA release by endothelial cells.

This observation merits further investigation, in particular because TNF does not cause the rapid release of t-PA from endothelial cells in vitro, even in the presence of plasma or serum, which suggests that other cells may be involved in TNF-induced activation of the fibrinolytic system in vivo. . . . [Full Text PDF of this Article]

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