Thrombin activatable fibrinolysis inhibitor (TAFI) is a zymogene that potently inhibits fibrinolysis. It is synthesized by the liver and has an inhibitor role in fibrinolysis through the removal of the carboxy-terminal lysine and arginine residues from partially degraded fibrin polymers. Besides, TAFI has a suppressor effect on conversion of inactive plasminogen to plasmin. Alterations in TAFI pathway have been reported in many conditions. Few data are present in the literature regarding the relationship between TAFI and endocrine disorders. The results from few studies in patients with cardiovascular disease are conflicting. Understanding the role of TAFI in the pathogenesis of endocrine and cardiovascular disorders may hold promise for improving management of these diseases. This paper includes a review of the studies and patents concerned with TAFI pathway and endocrine and cardiovascular problems. © 2008 Bentham Science Publishers Ltd.