Summary. Studies from our laboratory have demonstrated that von Willebrand factor (VWF) stimulates thrombin generation in platelet-rich plasma. The precise role of VWF and fibrin in this reaction, however, remained to be clarified. In the present study we utilized thrombin-free planar fibrin layers and washed platelets to examine the relationship between platelet-fibrin interaction and exposure of coagulation-stimulating phosphatidylserine (PS) under conditions of low and high shear stress. Our study confirms that platelet adhesion to fibrin at a shear rate of 1000 s À1 requires fibrin-bound VWF. ), but only a minority of the platelets (11 AE 8%) exposed PS. The essential role of VWF in this thrombin-induced procoagulant response became apparent from low shear rate perfusion studies over fibrin that was incubated with VWF and botrocetin. After treatment with thrombin, the majority of the adherent platelets (57 AE 23%) exposed PS and had peak values of [Ca 2þ ] i of about 0.6 mmol L À1 . Taken together, these results demonstrate that thrombin-induced exposure of PS and high calcium response on fibrin-adherent platelets depends on shear-or botrocetin-induced VWF-platelet interaction.Keywords: fibrin, platelet procoagulant activity, von Willebrand factor.Thrombus formation at an injured vessel wall involves platelet adhesion, platelet activation and fibrin formation. Previous studies have provided evidence that fibrin, besides physically entrapping platelets [1], may also be involved in signal pathways that result in the exposure of anionic phospholipids (PS) at the plasma membrane of platelets [2,3]. The presence of PS in the outer leaflet of the platelet plasma membrane is of physiological importance because of its critical role in maintaining thrombin generation at the surface of a developing thrombus [4]. Platelets adhere to fibrin by molecular mechanisms that vary with the surface shear rate [5,6]. At low shear rates, platelet adhesion is mediated by integrin a IIb b 3 whereas at high shear rates an interaction between platelet glycoprotein (GP) Ib and fibrin-bound von Willebrand factor (VWF) tethers the platelets as a prerequisite for an irreversible, integrin a IIb b 3 -mediated, adhesion to fibrin [7][8][9][10].Recently, conflicting reports appeared on the role for GPIb in the development of procoagulant platelets. Studies in plateletrich plasma revealed that VWF supports thrombin generation by two mechanisms: one that involves integrin a IIb b 3 but not fibrin and another one that depends on both fibrin and GPIb [3]. Other investigators studied the thrombin-dependent expression of procoagulant activity in suspensions of gel-filtered platelets and found that the GPIb binding site for thrombin, but not that for VWF, has a key role in the exposure of procoagulant phospholipids on the platelet surface, implying that VWF does not function in this response [11]. Earlier studies, however, indicated that PAR1 is the primary mediator of thrombin-stimulated platelet procoagulant activity, implicating that GPIb doe...