The adhesion of platelets to the subendothelium of blood vessels at sites of vascular injury under high shear conditions is mediated by a direct interaction between the platelet receptor glycoprotein Ib␣ (GpIb␣) and the A1 domain of the von Willebrand factor (VWF). Here we report the 2.6-Å crystal structure of a complex comprised of the extracellular domain of GpIb␣ and the wild-type A1 domain of VWF. A direct comparison of this structure to a GpIb␣-A1 complex containing "gain-offunction" mutations, A1-R543Q and GpIb␣-M239V, reveals specific structural differences between these complexes at sites near the two GpIb␣-A1 binding interfaces. At the smaller interface, differences in interaction show that the ␣1-2 loop of A1 serves as a conformational switch, alternating between an open ␣1-2 isomer that allows faster dissociation of GpIb␣-A1, as observed in the wild-type complex, and an extended isomer that favors tight association as seen in the complex containing A1 with a type 2B von Willebrand Disease (VWD) mutation associated with spontaneous binding to GpIb␣. At the larger interface, differences in interaction associated with the GpIb␣-M239V platelet-type VWD mutation are minor and localized but feature discrete ␥-turn conformers at the loop end of the -hairpin structure. The -hairpin, stabilized by a strong classic ␥-turn as seen in the mutant complex, relates to the increased affinity of A1 binding, and the -hairpin with a weak inverse ␥-turn observed in the wild-type complex corresponds to the lower affinity state of GpIb␣. These findings provide important details that add to our understanding of how both type 2B and platelet-type VWD mutations affect GpIb␣-A1 binding affinity.