The case-control study involved 53 patients aged 46 to 76, including 28 subjects with myocardial infarction (ACS); 16 STEMI and 12 NSTEMI, and 25 patients with stable coronary artery disease (CAD). An activation of coagulation in response to microvascular injury and in whole blood was measured in ACS patients in comparison with CAD. Concentrations of imuunoreactive and active tissue factor (TF) and active factor (F) XI in ACS were assessed and their influence on local hemostasis was investigated. Also an impact of statin use prior to myocardial ischemia on hemostasis in ACS patients was measured. The study showed strong activation of plasma coagulation and platelets in ACS patients, and particularly in STEMI. ACS and especially STEMI was associated with more frequent presence of active TF and active FXI in circulating blood and their concentrations correlated with thrombin generation assessed in whole blood and in the microvascular injury model. The systemic activation of coagulation and inflammation in ACS enhances thrombin generation and platelet activation at the site of microvascular injury. Thrombin generation in response to microvascular injury ACS patients correlated with interleukin-6 but not C-reactive protein. Use of statins prior to ACS significantly attenuates thrombin generation after vascular injury but has no influence on platelet activation.