Preeclampsia is a hypertensive disorder of pregnancy associated with significant maternal and fetal complications. Its pathogenesis involves endothelial dysfunction, abnormal placentation, and coagulation abnormalities, leading to increased thrombotic and hemorrhagic risks. This narrative review provides an in-depth overview of the pathophysiological mechanisms underlying preeclampsia, with a particular focus on its thrombotic and hemorrhagic complications. Treatment strategies are explored, with emphasis on the role of low-dose aspirin in reducing early-onset preeclampsia. However, aspirin's effectiveness varies based on dosage and timing, with higher doses showing greater benefit in preventing severe preeclampsia. Despite aspirin's widespread use, further optimization of its therapeutic role remains necessary to enhance maternal and fetal outcomes.