Venous thromboembolism is the third most common cardiovascular disease worldwide, including deep vein thrombosis in the lower extremities and pulmonary embolism, affecting approximately 5% of the global population. It has a high recurrence rate and mortality rate, and poses a significant burden. The traditional Virchow triangle theory laid the foundation for its pathological research. Platelets, as a key component, undergo a complex and multi-dimensional activation process, not only initiating and amplifying the coagulation cascade reaction, but also constructing a thrombogenic network through interactions with immune cells, endothelial cells, etc. This article elaborates on the core mechanism, driving pathways, specific pathological effects, and clinical value of platelet activation in venous thromboembolism, combined with insights from clinical practice and cutting-edge research, with the aim of providing new ideas for the prevention and treatment of venous thromboembolism.