SERPINA10 (serpin family A member 10), also known as Z-dependent protease inhibitor (ZPI), is a 72 kDa serine protease inhibitor that functions as a key regulator of coagulation 1. Its primary mechanism involves inhibiting factor Xa activity in the presence of protein Z (cofactor), calcium, and phospholipids, with a reported 1000-fold enhancement of inhibition by protein Z 1. Additionally, SERPINA10 independently inhibits factor XIa without requiring cofactors 1. The protein circulates in plasma complexed with protein Z and is consumed during coagulation through proteolysis by factor Xa and factor XIa 1. Regarding disease relevance, SERPINA10 has been identified as genetically associated with venous thromboembolism (VTE) risk through proteome-wide Mendelian randomization analysis 2, though specific SERPINA10 mutations (R67X and W303X) showed no statistically significant increase in VTE risk in meta-analysis 3. The gene was incorporated into the Thrombo inCode (TiC) genetic risk score (rs2232698 variant) for improved VTE risk prediction 4. Beyond thrombosis, SERPINA10 has been identified in machine learning models as a potential diagnostic biomarker for autism spectrum disorder 5 and shows altered expression in neuroendocrine tumors and their metastases 6, 7, suggesting broader pathophysiological roles warranting further investigation.