TMBIM4 and neoplasm: Protein Z enhances by >1,000 fold the inhibition of factor Xa by Protein Z dependant protease inhibitor.29 Deregulation of the haemostatic system is often seen in malignancy with localised activation of coagulation at tumor sites facilitating cancer progression.30 Activation of factor X is critical in the coagulation pathway and it has been shown to play an important role in the deregulation of haemostasis seen in malignancy.31 Changes in expression of Protein Z in OC may be related to its role within this process.