Fig. 2
From: Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration
The role of coagulation in pleurodesis. In brief, under physiological conditions there is a balance between fibrinogenesis and fibrinolysis in the pleural space. This balance is determined by a sustainable release of a tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI 1) from pleural mesothelial cells. Intrapleural application of the sclerosing agents result in decreased activity of fibrinolysis and increased activity of intrapleural coagulation. These processes lead to the formation of fibrin mesh; see text for details. Solid lines represent stimulation, dashed lines represent inhibition; arrows with double strikethrough represent the mechanisms which significantly block the physiological pathways. This figure is a simplified diagram presenting the major pathways of fibrinolysis and fibrinogenesis during chemical pleurodesis. The actual mechanisms are probably more complex