Figure 50-41 Thrombin is generally accepted as a branching or amplification step in coagulation. One can see from the various proteins stimulated by it that it not only promotes coagulation but also stimulates fibrinolysis through tissue plasminogen activator (TPA) and coagulation control through the protein S/C system. In any given patient, it is not known which of these various reactions will predominate. (Redrawn from Miller RD, Lichtor JL [eds]: Atlas of Anesthesia: III. Preoperative Preparation and Intraoperative Monitoring. Philadelphia, Churchill Livingstone, 1997, p 15.5)