The preferred pathway for prothrombin activation by prothrombinase involves initial cleavage at Arg 320 to produce meizothrombin, which is then cleaved at Arg 271 to liberate thrombin. Exosite binding drives substrate affinity and is independent of the bond being cleaved. The pathway for cleavage is determined by large differences in V max for cleavage at the two sites within intact prothrombin. By fluorescence binding studies in the absence of catalysis, we have assessed the ability of the individual cleavage sites to engage the active site of Xa within prothrombinase at equilibrium. Using a panel of recombinant cleavage site mutants, we show that in intact prothrombin, the Arg 320 site effectively engages the active site in a 1:1 interaction between substrate and enzyme. In contrast, the Arg 271 site binds to the active site poorly in an interaction that is ϳ600-fold weaker. Perceived substrate affinity is independent of active site engagement by either cleavage site. We further show that prior cleavage at the 320 site or the stabilization of the uncleaved zymogen in a proteinase-like state facilitates efficient docking of Arg 271 at the active site of prothrombinase. Therefore, we establish direct relationships between docking of either cleavage site at the active site of the catalyst, the V max for cleavage at that site, substrate conformation, and the resulting pathway for prothrombin cleavage. Exosite tethering of the substrate in either the zymogen or proteinase conformation dictates which cleavage site can engage the active site of the catalyst and enforces the sequential cleavage of prothrombin by prothrombinase.Thrombin, the key effector product of the coagulation cascade, is produced by specific proteolysis of the zymogen precursor, prothrombin (1). The physiologically relevant catalyst for this reaction is considered to be prothrombinase, a complex that assembles through reversible interactions between the serine proteinase, factor Xa, and the cofactor protein, factor Va on membranes containing acidic phospholipids (2, 3). The fundamental role of this reaction system in normal hemostasis is evident from profound bleeding associated with deleterious mutations in any one of its components (4, 5).Prothrombinase acts specifically on prothrombin and is not known to catalyze cleavage of other coagulation zymogens at an appreciable rate. A series of studies have established a predominant role for interactions between extended surfaces on prothrombinase (exosites) and its protein substrate, independent of the active site of the catalyst, in determining function (6). Exosite binding drives substrate affinity and confers specificity by restricting the action of factor Xa within prothrombinase to protein substrate species that can engage the enzyme complex in this way (6). Docking of residues flanking the cleavage site in the substrate to the active site of factor Xa within prothrombinase occurs in a second, intramolecular binding step that contributes little to substrate affinity but has instead been proposed ...