Hirudin inactivates thrombin and reduces the immunogenicity of FVIII. FVIII−/−/C57BL/6 mice received 5 intraperitoneal injections of 1 μg FVIII (n = 5) only or 1 μg FVIII with 200 μg hirudin (n = 5). This experiment was repeated twice, and representative results are reported here. Seven days after the last injection, (A) serum samples were analyzed for antibody response (515 ± 168 [FVIII] vs 134 ± 16 [FVIII + hirudin] μg/mL; *P = .02) and (B) splenic T cells were assayed for the response to FVIII (*P < .002). These data indicate that thrombin is necessary for initiation of the immune response to FVIII.