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Abstract
Acute respiratory distress syndrome (ARDS) is defined as a syndrome of acute onset,
with bilateral opacities on chest imaging and respiratory failure not caused by cardiac
failure, leading to mild, moderate, or severe oxygenation impairment. The syndrome
is most commonly a manifestation of sepsis-induced organ dysfunction, characterized
by disruption of endothelial barrier integrity and diffuse lung damage. Imbalance
between coagulation and inflammation is a predominant characteristic of ARDS, leading
to extreme inflammatory response and diffuse fibrin deposition in vascular capillary
bed and alveoli. Activated platelets, neutrophils, endothelial cells, neutrophil extracellular
traps, microparticles, and coagulation proteases, participate in the complex process
of immunothrombosis, which is a key event in ARDS pathophysiology. The present review
is focused on the elucidation of immunothrombosis in ARDS and the potential therapeutic
implications.