Experimental, albeit conflicting, evidence suggests that the SARS CoV1 virus, which causes SARS, could activate transcription of a prothrombinase gene, coding Fibrinogen like 2 (FGL2)9. FGL2 is a multi functional protein that activates prothrombin to generate thrombin that in turn converts fibrinogen into fibrin, possibly explaining the extensive fibrin deposition in the lungs of SARS patients as well as inducing a prothrombotic state. Interestingly, the proteolytic activity of FGL2 is independent of factor X and cannot be inhibited by antithrombin III9, perhaps explaining LMWH’s apparent lack of efficacy in our patients..
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