MicroRNAs as potential biomarkers and future therapeutic targets in thrombosis: From molecular mechanisms to clinical implications

MicroRNAs (miRNAs) are small regulatory molecules that control protein synthesis, presenting promising opportunities for novel, mechanism-based therapies. Their roles are essential in the biological processes underlying thrombosis, including vascular function, coagulation, and platelet activity. Specific miRNAs, such as miR-126 and miR-223, that influence platelet activation and adhesion are particularly relevant to thrombotic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This positions them as intriguing targets for new therapeutic strategies. miRNA-based treatments, using synthetic mimics or inhibitors (antagomirs), offer a potential avenue for precisely modulated anticoagulant therapy. However, these approaches remain in early-stage development. Significant challenges must be overcome before miRNA therapies can achieve widespread clinical adoption. Further research is essential to elucidate miRNA function in venous thromboembolism (VTE) fully and to translate these insights into safe and effective treatments. This review summarizes current knowledge of the role of miRNAs in VTE, underscores their substantial therapeutic potential, and addresses the critical obstacles and practical limitations that must be resolved to realize their full promise in treating thrombotic diseases. Targeting important molecules in coagulation (e.g., miR-145 inhibits TF/FXI), platelet function (miR-126), endothelium homeostasis (miR-92a), fibrinolysis (miR-30c), and inflammation (miR-223), microRNAs (miRNAs) are important post-transcriptional regulators of hemostasis. During thrombus initiation, propagation, and resolution, their stage-specific dysregulation may tip the balance toward thrombosis. Clinical outcomes, including DVT, PE, and VTE, are associated with altered miRNA profiles, underscoring their dual roles as therapeutic targets and diagnostic biomarkers. MiRNA profiling opens the door to personalized treatment by enabling customized risk assessment and targeted antithrombotic strategies through bioinformatics and integration with clinical data 1,2.