Targeting natural anticoagulant proteins as a means to rebalance the hemostatic system is an emerging trend in the development of innovative therapeutic strategies for hemophilia. These 2 articles develop these concepts in the areas of hemostasis and contact activation. In the study by Aymonnier and colleagues, simple amino acid substitutions converted a serpin elastase inhibitor, α1-antitrypsin (α1AT), into a potent antithrombin, activated protein C inhibitor, or anti-PKa/FXIIa inhibitor. In the study by de Maat and colleagues, redesign of α1AT strongly altered its inhibitory behavior and enables it to be used for the treatment of contact system–mediated thrombosis and inflammation.