Thrombosis at the crossroads of inflammation, coagulation, and vascular biology: Recent advances and emerging therapeutic strategies

Thrombosis is a multifaceted pathological process involving intravascular clot formation that drives a range of cardiovascular and cerebrovascular diseases, including myocardial infarction, ischemic stroke, venous thromboembolism, and cancer-associated thrombosis. Despite major advances in anticoagulation and thrombolytic therapies, clinical outcomes remain limited by bleeding risk, incomplete clot dissolution, and variable patient response. Emerging evidence increasingly portrays thrombosis as a dynamic immunoinflammatory disorder, integrating coagulation, inflammation, and immune signaling into what is collectively termed thrombo-inflammation. Mechanistic insights have uncovered crucial roles for neutrophil extracellular traps (NETs), platelet-leukocyte interactions, complement activation, and metabolites derived from gut microbiota in facilitating the formation and persistence of thrombi. Translational research has mirrored this trend, with the development of innovative therapeutics such as Factor XI/XII inhibitors, RNA-based agents, and nanocarrier-guided delivery systems. These are crafted to precisely modulate antithrombotic efficacy while ensuring the preservation of hemostatic balance. At the same time, advancements in thrombolytic techniques, such as clot-sensitive fibrinolytics and interventions using ultrasound assistance and catheter guidance, provide treatment options focused on precision. Advances in diagnostic platforms, including artificial intelligence (AI) -enhanced imaging, microfluidic assays, and multi-omics biomarker profiling, are further transforming early detection and individualized risk stratification. This review brings together current molecular and translational insights to map out the evolving paradigm of thrombosis as a systemic, multifactorial process. It emphasizes the emerging connections among bioengineering, omics-based profiling, and artificial intelligence, showcasing their combined potential to revolutionize prevention, diagnosis, and treatment strategies. By integrating these multidimensional perspectives, this review aims to chart the path toward precision thrombosis medicine and mechanism-targeted therapeutic innovation.

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This review positions thrombosis as a thrombo-inflammatory process driven by neutrophil extracellular traps, platelet-leukocyte interactions, complement, and microbiota-derived metabolites. It also covers new therapeutics such as factor XI/XII inhibitors, RNA-based agents, and nanocarrier delivery, plus AI-enhanced diagnostics for early detection and risk stratification.

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