Exosomes refer to a group of extracellular vesicles naturally released from mammalian cells with a diameter of 30-150 nm. Exosomes contain a variety of biologically active molecules, such as cytoplasmic proteins, chemokines, cytokines, and microRNA (miRNA). They are widely involved in intercellular communication and regulate the behavior of recipient cells. Venous thrombosis is a pathological change caused by vascular endothelial cell damage, hemodynamic changes, and the hypercoagulable state of blood. Exosomes from different cell sources are involved in the process of venous thrombosis. Exosomes can also be used as therapeutic carriers for tissue regeneration and drug delivery. Therefore, the study of exosomes is crucial for the formation, diagnosis, and treatment of venous thrombosis. In this review, we summarize the biological characteristics of exosomes and their mechanism of action in venous thrombosis. In addition, we also focused on its potential clinical applications, including as a diagnostic marker and therapeutic carrier for venous thrombosis.