The serine protease thrombin is generated from its zymogen prothrombin at the end of the coagulation cascade. Thrombin functions as the effector enzyme of blood clotting by cleaving several procoagulant targets, but also plays a key role in attenuating the hemostatic response by activating protein C. These activities all depend on the engagement of exosites on thrombin, either through direct interaction with a substrate, as with fibrinogen, or by binding to cofactors such as thrombomodulin. How thrombin specificity is controlled is of central importance to understanding normal hemostasis and how dysregulation causes bleeding or thrombosis. The binding of ligands to thrombin via exosite I and the coordination of Na þ have been associated with changes in thrombin conformation and activity. This phenomenon has become known as thrombin allostery, although direct evidence of conformational change, identification of the regions involved, and the functional consequences remain unclear. Here we investigate the conformational and dynamic effects of thrombin ligation at the active site, exosite I and the Na þ -binding site in solution, using modern multidimensional NMR techniques. We obtained full resonance assignments for thrombin in seven differently liganded states, including fully unliganded apo thrombin, and have created a detailed map of residues that change environment, conformation, or dynamic state in response to each relevant single or multiple ligation event. These studies reveal that apo thrombin exists in a highly dynamic zymogen-like state, and relies on ligation to achieve a fully active conformation. Conformational plasticity confers upon thrombin the ability to be at once selective and promiscuous.allostery | hemostasis | protease | structure | zymogen B lood coagulation (hemostasis) is the result of a cascade of events where zymogens are converted to active proteases through the specific action of a preceding protease (1, 2). This process is tightly regulated to ensure that stable blood clots form rapidly at the site of tissue damage. Dysregulation by several mechanisms is the cause of bleeding disorders, including hemophilia, and of thrombosis, the most common cause of morbidity and mortality in the industrialized world. Most hemostatic proteases have only a single target and are regulated by a single cofactor. However, thrombin (Fig. 1), the final protease in the cascade, has over a dozen substrates and at least five cofactors (3). Thrombin is critical for the initiation, propagation, and attenuation of the hemostatic response, and in each of these phases the activity of thrombin is directed by cofactors (4, 5). Of principal importance are the cofactors that convert thrombin between pro and anticoagulant activities. Thrombomodulin (TM) is an integral membrane protein that alters thrombin specificity from the procoagulant substrates such as PAR1, factors V and VIII, and fibrinogen to specific activation of the anticoagulant protease protein C (6). This change of function is thought to be due to the bloc...