Inactivation of factor Va (FVa) by activated protein C (APC) is a key reaction in the downThe protein C pathway provides a major anticoagulant mechanism for the regulation of hemostasis by nullification of the procoagulant activities of FVIIIa and FVa, the cofactors in the tenase and prothrombinase complexes, respectively. Protein C is a vitamin K-dependent protein composed of a heavy chain and a light chain that are connected through a single disulfide bridge (1). The light chain is composed of an N-terminal ␥-carboxyglutamic acid-rich domain and two epidermal growth factor-like domains. The heavy chain contains a short (12 amino acid) signal peptide and the serine protease (peptidase) domain.Previously, we and others have demonstrated that three surface loops (37, 70, and 148, chymotrypsin numbering) in the serine protease domain of APC 2 form an extended FVabinding site (2-4). Furthermore, a cluster of basic residues located on loops 37, 60, and 70 form a positively charged exosite on the surface of APC important for its interaction with thrombomodulin, protein C inhibitor, ␣1-antitrypsin, and heparin (2, 5-7).APC is able to cleave FVa, the nonenzymatic cofactor of FXa in the prothrombinase complex, at least at five peptide bonds, of which those at Arg 306 and Arg 506 are considered most important for the inactivation of FVa (8 -10). FVa is a multidomain protein that consists of a 71/74-kDa light chain (A3, C1, and C2 domains) and a 105-kDa heavy chain (A1 and A2 domains) that are noncovalently associated. All APC cleavage sites are located in the FVa heavy chain (8). In the presence of negatively charged phospholipids, the cleavages at Arg 506 and Arg 306 are primarily responsible for inactivation of FVa (11). Cleavage of Arg 506 is kinetically favored over the Arg 306 cleavage (up to 20-fold rate difference) and results in an FVa inactivation intermediate with partial cofactor activity, whereas cleavage at Arg 306 fully inactivates FVa (11,12). In the presence of its cofactor protein S, however, APC cleaves the Arg 306 peptide bond with a rate that is approximately similar to that of cleavage at Arg 506 (13). Heparin is a naturally occurring sulfated glycosaminoglycan that can be found in several organs and tissues of the human body, notably on the surface of endothelial cells that form the inner lining of our vasculature. Unfractionated heparin (UFH) and low molecular weight heparin are widely used as effective pharmacotherapeutics for the prevention and treatment of thrombosis. The anticoagulant functions of heparin are diverse and include stimulation of the inhibition of various coagulation factors (thrombin, FIXa, FXa, FXIa, and FXIIa) by antithrombin as well as inhibition of platelet functions (14 -17). Apart from its anticoagulant functions, heparin also has anti-inflammatory properties as it modulates the production and release of proinflammatory factors (18).* This work was supported by VIDI Grant 916-046-330 from the Dutch Organization for Scientific Research (to G. A. F. N.). The costs of publica...