Osteoarthritis (OA) is a common joint disease affecting more than 500 million people worldwide, with a prevalence rate of 60 % among individuals aged 60 and above. Platelet aggregation plays a crucial role in the pathogenesis of OA, as it is involved in the inflammatory response, among other processes. This paper examines the role of platelet aggregation in the pathogenesis of OA over the past five years (2020–2024). Platelet aggregation releases inflammatory mediators, activating inflammatory signaling pathways and inducing joint inflammation. The release of these mediators can disrupt the proliferation and metabolism of chondrocytes, leading to apoptosis and the destruction of cartilage structure. It also enhances the permeability of synovial blood vessels and stimulates the proliferation of synovial cells, resulting in synovial hyperplasia and joint swelling. Moreover, studies over the past five years have shown that active ingredients of Traditional Chinese Medicines (TCMs) can treat OA by regulating platelet aggregation. Forty-two active ingredients of TCMs and six Chinese medicinal formulations were analyzed, including active ingredients of TCMs such as tanshinone IIA and paeoniflorin. These ingredients can treat OA by anti-inflammatory, modulating signaling pathways such as mitogen-activated protein kinase/nuclear factor kappa-B (MAPK/NF-κB), and protecting cartilage. These active ingredients can serve as an alternative and valuable source of treatment for OA. Currently, the relationship between platelet aggregation and OA is not yet fully understood, and further research and exploration are necessary.