The protein C anticoagulant system provides important control over the blood coagulation cascade. Any alteration in this pathway, either hereditary, iatrogenic, or otherwise, may interfere with normal coagulation. In this review, current concepts and understanding of surface-dependent hemostatis are reviewed, effects of deficiencies in the intrinsic anticoagulant system are described, and potentially useful therapeutic strategies are proposed. The importance of protein C, protein S, and thrombomodulin in patients undergoing cardiac surgery is specifically addressed. Further work is required before complex interactions of individual components of the intrinsic anticoagulation pathway are fully understood.
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