<p>Cardiovascular diseases (CVD) stand as the foremost cause of global mortality, significantly affecting healthcare systems. The use of mediated/implantable medical devices is considered to be an effective treatment for CVD. However, due to the interaction of these materials with the biological environment, they often lead to complications such as thrombosis, inflammation and endothelial dysfunction which have a negative impact on clinical outcomes. This review explores the underlying mechanisms contributing to these adverse reactions and emphasizes surface modification strategies aimed at enhancing the biocompatibility of blood-contacting materials. By categorizing coating techniques into bio-inert and bioactive approaches, we delineate current research advancements and their effectiveness in improving device performance. Furthermore, we also conduct an in-depth exploration of the potential of bionic coatings, inspired by natural cellular environments, to mimic the physiological properties of endothelial. The approach not only improve hemocompatibility, but also for promoting rapid endothelial cell generation and alleviating complications associated with long-term implants. In conclusion, this review highlights the necessity for sustained research and development of surface modification technologies, with the goal of advancing safer and more effective cardiovascular devices that improve patient outcomes and quality of life.</p> Graphical Abstract <p></p>