Increased thrombin activation was documented in patients with abdominal aortic aneurysm (AAA). Activated protein C-protein C inhibitor (APC-PCI) complex, a new biological marker of thrombin generation, was measured in a population of 232 patients with AAA and a control group, and the association between aneurysm size, growth rate, and APC-PCI was studied. The patients were divided into cohorts according to AAA diameter and compared with a control group. APC-PCI was significantly higher in all AAA cohorts (n = 232; median, 0.36 microg/L; 10th to 90th percentile, 0.18-1.01) compared with the control group (n = 41; median, 0.19 microg/L; 10th to 90th percentile, 0.11-0.31; P < or = .001). APC-PCI correlated with AAA diameter (r = .22; P = .001), body mass index (r = -.19; P = .004), and age (r = .19; P = .004). APC-PCI did not correlate with AAA growth rate (r = .11; P = .14).