A detailed understanding of the hemostatic process and the pathogenesis of thrombosis provides the basis for the development of more selective and potentially more efficient antithrombotic agents. These may allow to tailor antithrombotic treatment strategies for specific disease entities according to relative risk and prevailing pathogenetic mechanisms. Conversely, the use of selective pharmacological inhibitors has become an indispensable tool in experimental hemostasis and thrombosis research. Recent advances in the field have prompted profound reappraisal of concepts and hypotheses related to blood coagulation, thrombogenesis and the biologic role of the plasminogen activator-plasmin system. The present article will focus on the various mediator functions of thrombin, on the key role of tissue factor in the initiation of blood coagulation, and on the potential relevance of the tissue factor pathway inhibitor (TFPI).