Abstract: Multiple myeloma (MM) is a malignancy characterized by the abnormal proliferation of clonal plasma cells. It is often associated with coagulation abnormalities, posing risks of thrombosis, thromboembolism, and bleeding, including severe cases, which are related to decreased quality of life, delayed or discontinued treatment, and reduced survival. Disease, individual-specific factors, and therapeutic agents affect the dynamic balance of coagulation, anticoagulation, and fibrinolytic systems in patients with MM. The diagnosis and treatment of underlying coagulation disorders are challenging due to the involvement of multiple mechanisms. In addition, newly introduced therapies such as immunomodulatory drugs, proteasome inhibitors, chimeric antigen receptor-modified T-cell therapy, and monoclonal antibodies also impact coagulation in patients with MM. This review discusses the influencing factors, pathophysiological mechanisms, and prevention and treatment strategies for coagulation abnormalities in MM.