Purpose of Review <p>This review summarizes current evidence on coagulation and fibrinolysis markers in chronic thromboembolic pulmonary hypertension (CTEPH) and discusses the potential impact of reperfusion therapies, with particular emphasis on balloon pulmonary angioplasty (BPA).</p> Recent Findings <p>Beyond mechanical obstruction, CTEPH is increasingly associated with persistent abnormalities in coagulation, fibrinolysis, platelet function, and endothelial homeostasis. Enhanced coagulation activation, abnormal fibrin clot structure, impaired fibrinolysis, and dysregulation of endogenous anticoagulant pathways may contribute to thrombus non-resolution and vascular remodeling. Recent data suggest that BPA not only improves pulmonary hemodynamics and right ventricular function but may also modulate coagulation–fibrinolysis pathways.</p> Summary <p>Hemostatic and fibrinolytic disturbances in CTEPH appear to extend beyond persistent vascular obstruction. Understanding the behavior of these biomarkers may improve insight into disease mechanisms, treatment response, and future individualized management strategies, particularly in patients undergoing contemporary reperfusion therapies.</p>