The central role of thrombin in blood clotting is well established. The classic function of thrombin in this pro cess is to cleave fibrinogen, a reaction that leads to for mation of the fibrin gel, the essential constituent of the blood clot. However, thrombin also has important regu latory functions in blood clotting. It thus activates the cofactors, Factor V and Factor VIII, of the clotting sys tem in a positive feedback loop that greatly accelerates the generation of the enzyme and thereby increases the rate of fibrin formation. In addition, thrombin can also retard blood clotting in a negative feedback loop. When bound to a membrane protein, thrombomodulin, on the endothelial cell surface, thrombin thus activates protein C, which in turn inactivates Factors V and VIII, thereby decreasing the rate of generation of thrombin and conse quently also of fibrin. A further function of thrombin is to activate Factor XIII, which then stabilizes the clot by covalent crosslinks. These divergent roles of thrombin in the clotting system suggest that precise control of the activity of the enzyme is of paramount importance for normal hemostasis.The activity of thrombin generated in the clotting process has been shown to be predominantly regulated by inactivation of the enzyme by four different plasma pro teinase inhibitors. Two of these, α 1 -proteinase inhibitor and α 2 -macroglobulin, are general proteinase inhibitors that can inactivate a number of enzymes, whereas the other two, antithrombin and heparin cofactor II, are more specific for thrombin and, in the case of antithrombin, also other coagulation proteinases. The latter two inhibi tors also have in common that the rate of their inactiva tion of thrombin is greatly accelerated by the binding of heparin and certain similar glycosaminoglycans.In this work we will review the structure and func tion of antithrombin, the physiologically most important of the two specific thrombin inhibitors. We will discuss the properties of antithrombin and how it inactivates thrombin and other clotting proteinases. We will also present current knowledge regarding the binding of hep arin to antithrombin and thrombin or other proteinases and the role of these interactions in the mechanism by which heparin accelerates the inhibition of the protein ases by the inhibitor. Finally, we will discuss the physio logical role of antithrombin and heparin-like polysaccha rides and how other proteins in plasma, on the vessel wall, or released by platelets and neutrophils may modu late the effect of heparin in accelerating proteinase inacti vation by antithrombin.