ATP, released at sites of vascular injury, interacts with P2X1 cation channels on PMNs and platelets to induce release of neutrophil elastase and cathepsin G and recruit platelets to the site of injury. Locally released elastase and cathepsin G inhibit TFPI, thereby releasing its inhibitory effect on locally activated tissue factor to allow coagulation generation of the fibrin clot to proceed. With increasing distance to the site of injury, ATP is hydrolyzed by ectonucleotidases (CD39) to ADP and AMP and further metabolized to adenosine. Adenosine inhibits PMN activation (and also elastase release) through interaction with A2A adenosine receptors on PMN surfaces to restrict PMN activation, and therefore coagulation, to the site of injury. A2A-R, adenosine receptor; EC, endothelial cell; plt, platelet.