Vascular thrombotic inflammation is the most serious complication of cardiovascular disease, and the platelet and coagulation cascades are effective targets for antithrombotic methods. However, the application of traditional antiplatelet drugs is limited to a certain extent due to their various side effects, such as bleeding risk and drug resistance. New evidence showed that gut microbiota is considerably associated with thrombotic inflammation, and targeted microbial pathways can promote beneficial 'antiplatelet' effects and decrease the promotion of thrombosis, without bleeding complications. Owing to the advantages of multiple components and targets, traditional Chinese medicines (TCMs) can affect vascular thrombotic inflammation by regulating the composition of the gut microbiota, improving the intestinal mucosal barrier, and affecting the level of gut microbiota-derived metabolites. Targeting gut microbiota pathways using TCM is a promising therapeutic strategy for suppressing thrombotic inflammation. TCMs also exhibit beneficial effects in treating patients with various thrombosis-related inflammatory conditions owing to the antithrombotic and anti-inflammatory properties. In this review, we introduce and summarize the most recent research advances in gut microbiota and vascular thrombotic inflammation, highlighting the role of the gut microbiota. In addition, a comprehensive overview of the regulation of vascular thrombotic inflammation using TCMs that target gut microbiota, and limitations and prospects of the current research are discussed. This study provides new insights for treating vascular thrombosis inflammatory diseases and lays a foundation for future research.