Abstract-We examined the effect of adherent neutrophils on fibrin deposition under laminar flow conditions. Perfusion of recalcified citrated platelet-free plasma (PFP) over neutrophils adherent to fibrinogen-coated glass at a venous wall shear rate of 62.5 s Ϫ1 for 15 minutes resulted in dense deposition of fibrin around each neutrophil, whereas fibrin deposition on glass alone was sparse. Fibrin deposition on neutrophils was markedly reduced by anti-CD18 or anti-CD11b or a higher shear rate (250 s Ϫ1 ). Significantly less fibrin was deposited around adherent fibrinogen-coated beads, indicating that nonspecific "cross-sectional capture" effects were not responsible for the massive fibrin deposition on neutrophils. Direct visualization of fibrin capture by neutrophils and elimination of fibrin deposition at 15 minutes by a factor XIIa inhibitor (50 g/mL corn trypsin inhibitor [CTI]) or elastase/cathepsin G inhibitors (MethoxysuccinylAla-Ala-Pro-Ala-Chloromethyl-Ketone/Z-Gly-Leu-Phe-CMK, 100 mol/L) indicated that neutrophils can capture short fibrin strands flowing in recalcified PFP lacking CTI and can also promote thrombin generation through pathways attenuated by inhibitors of factor XIIa, elastase, and cathepsin G. When neutrophils were allowed to interact with platelets on a fibrinogen surface before perfusion of recalcified CTI-treated PFP, the fibrin deposition was observed to be dramatic compared with that over surfaces coated with platelets alone or neutrophils alone and compared with that formed on platelets adherent to collagen. This neutrophil promotion of platelet-mediated fibrin formation was attenuated by inhibitors of elastase or cathepsin G but not anti-tissue factor antibody. Neutrophils can interact with platelets via released proteases to increase platelet procoagulant activity and fibrin formation in CTI-treated plasma under the low-flow conditions expected in venous thrombosis or inflammation. Key Words: P-selectin Ⅲ CD11b/CD18 Ⅲ thrombin Ⅲ deep vein thrombosis B lood coagulation on the inner wall of blood vessels is the major cause of cardiovascular diseases, such as deep vein thrombosis, myocardial infarction, and stroke. In a Dacron graft model, Palabrica et al 1 showed that neutrophils enhance fibrin deposition through P-selectin-dependent mechanisms. Adherent neutrophils may promote thrombosis via pathways such as deencryption of tissue factor, 2 release of proteases that activate platelets, 3,4 Mac-1 (CD11b/CD18) binding of factor X, 5 and improved capture of flowing platelets via protrusion into the flow stream. 6 The capture of neutrophils by the vessel wall involves neutrophil P-selectin glycoprotein ligand-1 (PSGL-1)-mediated rolling 7 and membrane tethering 8 on P-selectin presented by activated endothelium or spread platelets, 9 followed by  2 -integrin-mediated firm arrest. 10 The neutrophil  2 -integrin Mac-1, when upregulated, can bind endothelial intercellular adhesion molecule-1 and an unknown platelet ligand, 11 which may be glycoprotein Ib␣. 12 Adherent neutrophils can a...