Von Willebrand factor (VWF) is a large, multimeric plasma glycoprotein that critically mediates hemostasis at sites of vascular injury. Very large VWF multimers have the greatest thrombogenic activity, which is attenuated by cleavage in the A2 domain by the metalloproteinase ADAMTS13. ADAMTS13 proteolysis requires mechanical force to expose the scissile bond and is regulated by a calcium-binding site within A2. In this study, we characterized the interaction between VWF A2 and calcium by examining the effect of calcium on VWF A2 stability and mechanical unfolding and refolding. Isothermal calorimetry yielded a calcium binding K d ¼ 3.8 AE 1.0 μM and reversible thermal denaturation showed that 5 mM calcium stabilized the unfolding transition from 56.7 AE 0.1 to 69.1 AE 0.1°C. Using optical tweezers to apply tensile force to single domains, we found that calcium did not affect VWF A2 unfolding, but rather enhanced refolding kinetics fivefold, resulting in a 0.9 kcal∕mol stabilization in the folding activation energy in the presence of calcium. Taken together, our data demonstrate that VWF binds calcium at physiologic calcium concentrations and that calcium stabilizes VWF A2 by accelerating refolding. V on Willebrand factor (VWF) is a large plasma glycoprotein that critically mediates hemostasis at sites of vascular injury. Secreted by endothelial cells and platelets in response to thrombogenic stimuli, VWF circulates as ultralong, disulfide-bonded concatamers (1) reaching >12 MDa and >15 μm in size (2, 3). Each VWF monomer is comprised of multiple domains, including domains that bind clotting factor VIII, collagen, platelets, and integrins (1). The A2 domain contains a cleavage site recognized by the enzyme ADAMTS13 (a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13), which regulates VWF length. The largest VWF concatamers mediate the formation of a platelet plug through multivalent binding to collagen and platelet membrane glycoprotein Ib. Mutations within VWF cause von Willebrand's disease (VWD), a heterogeneous set of bleeding disorders that underscore VWF function in normal physiology (4).VWF function is critically determined by concatamer length. Healthy individuals exhibit a heterogeneous distribution of VWF concatamers, whose size is regulated through specific cleavage by ADAMTS13. Absence of ADAMTS13 function causes thrombocytic thrombocytopenic purpura (TTP), a life-threatening condition characterized by extensive microvascular thromboses that result in tissue ischemia and infarction. Neurologic symptoms and renal failure are often described, and the condition resolves upon replenishment of ADAMTS13 with plasma exchange (5). In contrast, genetic mutations that shift the VWF size distribution to smaller multimers, comprising type 2 VWD, present with increased bleeding due to reduced VWF thrombogenicity (6). Subtype 2A VWD mutations cluster within the A2 domain, which bears the ADAMTS13 cleavage site, and whose structure illuminates mechanisms that regulate VWF cleavage (7).Flu...