Thrombin is a Na
+
‐activated, allosteric serine protease that plays opposing functional roles in blood coagulation. Binding of Na
+
is the major driving force behind the procoagulant, prothrombotic, and signaling functions of the enzyme, but is dispensable for cleavage of the anticoagulant protein C. The anticoagulant function of thrombin is under the allosteric control of the cofactor thrombomodulin. Thrombin exists in three forms, E*, E, and E:Na
+
, which interconvert under the influence of ligand binding to distinct domains. Transitions among these forms control key functional aspects of the enzyme.