The latest advances in basic and clinical research on the main components of the platelet serotonergic system are presently reviewed. These components consist of serotonin (5-HT), enzymes that participate in 5-HT metabolism, the serotonin transporter (SERT), and 5-HT1A, 5-HT2A, 5-HT3, and 5-HT4 receptors (each with their corresponding mechanism of intracellular transduction). An additional focus is on related biomarkers or drugs for the diagnosis or treatment of the pathophysiology of diverse disorders such as depression, anxiety, hemorrhagic dengue, coagulopathy generated by COVID-19, myocardial infarction, and preeclampsia. The drugs analyzed include serotonin reuptake inhibitors and serotonergic drugs that act on 5-HT receptors. Through the platelet serotonergic system, serotonergic drugs not only interact with the central nervous system but also may participate in coagulation, vascular permeability, and peripheral vascular resistance, which has many implications. Finally, perspectives are offered for future research on biomarkers and new therapeutic targets.