IntroductionThe importance of the platelet in normal hemostasis and in disease states, such as atherosclerosis and thrombosis, is well established. [1][2][3][4][5] A particularly germane example is the platelet-rich thrombus, which forms on fissured or ruptured atherosclerotic plaques. [3][4][5] Although the slow formation of the underlying plaques is a progressive disease that serves to narrow the lumen of the vessel over an extended period of time, it is the sudden and catastrophic superposition of the platelet-rich thrombotic occlusion on these lesions that is central to nearly all ischemic coronary events. General acceptance that the ultimate occlusive event is thrombotic in nature has led to the development of strategies that attempt to ameliorate, inhibit, or reverse this final phase of the coronary disease process. Some of the newest strategies focus on inhibition of platelet functions, which contribute to the formation of the thrombotic occlusion.The generation of thrombin during the blood clotting process can be divided into 2 semidiscrete intervals, the initiation and propagation phases. 6 During the initiation phase nanomolar amounts of thrombin and picomolar amounts of other coagulation enzymes are generated. Clot occurs at the inception of the propagation phase, which is characterized by rapid and near quantitative thrombin generation. By this point activation of platelets and cleavage of factor V and factor VIII are almost complete. 7 In normal blood, the thrombin activation process is independent of platelet or factor V activation, but is limited by the generation of factor Xa. 6,7 Normal platelet function has been divided into 3 processes: adhesion, aggregation, and activation (including surface phospholipid rearrangements and secretory pathways [8][9][10][11] ). These functions bestow on the platelet its antihemorrhagic qualities and are regulated by a variety of mechanisms. 12 The most potent platelet agonist is ␣-thrombin, the central enzyme of coagulation that controls hemorrhage in vivo. Thrombin is generated from the inactive circulating precursor prothrombin via the tissue factor (TF) pathway of coagulation [13][14][15][16] ; this serine protease activates platelets via specific cell surface receptors, leading to secretion, aggregation, changes in platelet morphology, and expression of a procoagulant, phospholipid-equivalent, surface. 9-11 Aggregated thrombin-activated platelets form the basis of the thrombus in normal hemostasis and provide the surface on which the complexdependent reactions of the TF pathway are localized. Furthermore, thrombin amplifies its own generation by activating circulating plasma procofactors (factor V and factor VIII), critical components of the pathway's proteolytic complex catalysts, which also serve to localize proteolytic activity to the surface of the activated platelet. 6,17 Thrombin converts fibrinogen by limited proteolysis to fibrin, which polymerizes throughout the growing thrombus rendering added stability. [18][19][20] The importance of TF-induced t...