Recurrent spontaneous abortion (RSA) refers to three or more consecutive spontaneous abortions before the 20th week of gestation. According to the research data of World Health Organization, worldwide, RSA has affected about 1–5 % of women of childbearing age, bringing great physical damage and psychological pressure to patients. The etiology of RSA is very complex, involving genetic factors (couples chromosome abnormalities or embryo chromosome abnormalities), physiological and structural factors (uterine congenital malformations, etc.), endocrine disorders, immune system abnormalities and prethrombotic state and many other factors. In recent years, Prethrombotic state (PTS) has been considered as one of the important causes of RSA, which is characterized by hypercoagulation, defects of anticoagulant mechanism or reduced fibrinolytic activity, leading to placental microcirculation dysfunction, and further leading to abortion. However, although RSA and PTS have been extensively studied by many researchers, the association between PTS and RSA is still not clear. This paper reviews the pathophysiological mechanism between PTS and RSA, as well as the early screening and diagnosis of PTS, and summarizes the clinical treatment of RSA related to PTS, in order to provide a solid theoretical basis for the follow-up treatment of RSA related to PTS.