The initial surface reactions of the extrinsic coagulation pathway on live cell membranes were examined under flow conditions. Generation of activated coagulation factor X (fXa) was measured on spherical monolayers of epithelial cells with a total surface area of 41-47 cm 2 expressing tissue factor (TF) at >25 fmol/cm 2 . Concentrations of reactants and product were monitored as a function of time with radiolabeled proteins and a chromogenic substrate at resolutions of 2-8 s. At physiological concentrations of fVIIa and fX, the reaction rate was 3.05 ؎ 0.75 fmol fXa/s/cm 2 , independent of flux, and 10 times slower than that expected for collision-limited reactions. Rates were also independent of surface fVIIa concentrations within the range 0.6 -25 fmol/cm 2 . The transit time of fX activated on the reaction chamber was prolonged relative to transit times of nonreacting tracers or preformed fXa. Membrane reactions were modeled using a set of nonlinear kinetic equations and a lagged normal density curve to track the expected surface concentration of reactants for various hypothetical reaction mechanisms. The experimental results were theoretically predicted only when the models used a slow intermediate reaction step, consistent with surface diffusion. These results provide evidence that the transfer of substrate within the membrane is rate-limiting in the kinetic mechanisms leading to initiation of blood coagulation by the TF pathway.Blood coagulation reactions mediate fibrin deposition in hemostasis and many pathological processes. Blood clots are directly implicated in the lethal complications of cardiovascular disease and contribute significantly to the pathogenesis of infectious, autoimmune, and neoplastic diseases (1-6).The blood coagulation process is initiated by an assembly of complexes comprised of an essential cofactor, TF 1 (tissue factor) and a protease component, fVIIa. The functional complex, TF⅐fVIIa, cleaves the natural substrates, fVII, fIX (factor IX), and fX at specific sites, generating fVIIa, fIXa, and fXa, respectively (4 -6). Factors VII, IX, and X circulate in the blood and extravascular fluids (7-10), whereas TF is expressed on the membranes of many extravascular tissues (11). The anatomic distribution of cells expressing TF is consistent with its role as the initiator of hemostatic reactions. Cell surfaces in contact with blood do not appear to express functional TF constitutively. However, inflammatory stimuli induce expression of functional TF on endothelial cell membranes and blood monocytes (12-14).Factors VII, IX, and X are vitamin K-dependent proteins, and their functional interaction with negatively charged procoagulant membranes has a calcium-dependent, electrostatic component (15-19). The interaction sites are located in highly homologous ␥-carboxyglutamic acid (Gla)-rich regions near the N terminus of all vitamin K-dependent coagulation proteins (4, 19). The specific binding and functional kinetics of interaction between coagulation proteins and biological membranes have been ...