Abstract As shown previously for activated Factor X and Ca2+ alone, (Esmon, C. T., and Jackson, C. M. (1974) J. Biol. Chem. 249, 7782–7790) prothrombin activation by activated Factor X and Ca2+ in the presence of phospholipid also proceeds via Intermediate 2 and Fragment 1·2, i.e. [see PDF for equation] Unless rapidly inactivated, thrombin cleaves Fragment 1·2 into two smaller activation products, i.e. Fragment 1·2 (Thrombin)/→ Fragment 1 + Fragment 2 2) The direct and concomitant formation of Intermediate 2 and Fragment 1·2 was demonstrated by activating prothrombin in the presence of iPr2P-F. In the absence of this inhibitor, thrombin, in addition to catalyzing the reaction of Equation 2, cleaves Fragment 1 from prothrombin and in so doing eliminates the possibility of observing phospholipid catalysis from all but the earliest stages of reaction (Gitel, S. N., Owen, W. G., Esmon, C. T., and Jackson, C. M. (1973) Proc. Nat. Acad. Sci. U. S. A. 70, 1344–1348). The reaction of Equation 1 was shown to occur independent of any special effect of diisopropyl fluorophosphate (iPr2P-F) by a direct demonstration of Intermediate 2 and Fragment 1·2 formation from tritium-labeled prothrombin. Both the formation of Intermediate 2 and its conversion to thrombin are accelerated by phospholipid. However, in the presence of phospholipid, Intermediate 2 was found to satisfy the necessary condition for an intermediate on a sequential activation path, i.e. that its rate of conversion to thrombin be greater than or equal to the rate of prothrombin conversion to thrombin, if and only if, Fragment 1·2 were also present in the activation mixture. In view of this observation, the true activation intermediate of the phospholipid-catalyzed pathway must consist of both Intermediate 2 and Fragment 1·2. Fragment 1 plus Fragment 2 was not able to substitute for Fragment 1·2. Intermediate 2 and Fragment 1·2 were demonstrated to associate noncovalently to form a product with gel electrophoretic properties indistinguishable from those of prothrombin. This association of Fragment 1·2 with Intermediate 2 apparently provides the mechanism by which Intermediate 2 can be retained on the phospholipid surface and thus be readily accessible to the activated Factor X for the final proteolysis which is required to form thrombin. An alternative prothrombin activation pathway which maintains the integrity of the Intermediate 2 and Fragment 1·2 portions of the prothrombin molecule during the two-step activation process was proposed previously (Esmon, C. T., Owen, W. G., and Jackson, C. M. (1974) J. Biol. Chem. 249, 606–611). No unambiguous evidence for the existence of the alternative activation route could be demonstrated and thus the reactions of Equation 1 appear to describe the principal, if not exclusive, pathway of prothrombin activation by Factor Xa, phospholipid, and Ca2+.