The interaction of platelets with collagen plays an important role in primary hemostasis. Glycoprotein Ia/ IIa (GPIa/IIa, integrin ␣ 2  1 ) is a major platelet receptor for collagen. The binding site for collagen has been mapped to the I domain within the ␣ 2 subunit (GPIa). In order to assess the role of the ␣ 2 -I domain structure in GPIa/IIa binding to collagen, a recombinant I domain (amino acids 126 -337) was expressed in Escherichia coli. The ␣ 2 -I protein bound human types I and III collagen in a saturable and divalent cation-dependent manner and was blocked by the ␣ 2  1 function blocking antibody 6F1. The ␣ 2 -I protein inhibited collagen-induced platelet aggregation (IC 50 ؍ 600 nM). Unexpectedly, 6F1, an antibody that fails to inhibit platelet aggregation in plateletrich plasma, blocked the inhibitory effect of the ␣ 2 -I protein. The ␣ 2 -I protein was able to prevent platelet adhesion to a collagen surface exposed to flowing blood under low shear stress. Interestingly, it inhibited platelet adhesion to extracellular matrix at high shear stress. These results, taken together, provide firm evidence that GPIa/IIa directly mediates the first contact of platelets with collagen under both stirring and flow conditions. Platelet adhesion to subendothelium at sites of vascular injury is a critical initial step in hemostasis. Platelets adhere to collagen by two mechanisms: directly by the interaction of platelet membrane proteins with collagen and indirectly via bridging molecules such as von Willebrand factor (vWF) 1 that bind to both platelet glycoprotein (GP) Ib␣ and collagen. This latter interaction is necessary to confer resistance to detachment under high flow and shear conditions. It also stabilizes platelet adhesion via the collagen receptor (1).GPIa/IIa (integrin ␣ 2  1 , VLA2, CD49b/29) is member of the integrin family of heterodimeric molecules that mediate both cell-cell adhesion and adhesion between cells and the extracellular matrix (ECM) (2). The integrin ␣ 2  1 is found on several different cell types, and its function may vary depending on the particular cell on which it is expressed. While it is a collagen receptor in platelets and fibroblastic cells, it functions as both a collagen and a laminin receptor on endothelial and epithelial cells (3, 4). It also acts as receptor for the human pathogen echovirus-1 (5) and is involved in the migration of tumor cells within collagenous matrices (6). Integrin ␣ 2  1 is a major collagen receptor in platelets (7). Although ␣ 2  1 -mediated adhesion appears to be an essential primary step in collagen-platelet interactions, it is still not known whether collagen-␣ 2  1 binding alone is sufficient to support platelet adhesion and to induce collagen-dependent platelet activation (8 -10). Platelets from patients described as having mild bleeding disorders due to deficient expression of either the ␣ 2 -integrin (11-14) or GPVI (15) have demonstrated impaired aggregation in vitro in response to collagen. Antibodies against the collagen receptor GPI...