Ischemic heart disease (IHD) is multifactorial with a complex etiology. Conventional risk factors including serum lipids account for less than one half of future IHD events. In the past few years, novel risk factors such as hemostatic and thrombotic factors contributing to the development and progression of IHD have been explored. Typically, diet is the first line of consideration in the prevention of IHD, but very little is known about the effect of diet and nutrients on hemostasis and thrombosis. Cross-sectional studies indicate that vegetarians may have a lower concentration of certain markers of hemostasis compared with nonvegetarians. Platelet aggregation, an index of thrombosis, appears to be higher among vegetarians than nonvegetarians, perhaps because of the lower intake of long-chain n-3 fatty acids among vegetarians. Monounsaturated-fat-rich plant foods may have a protective role in hemostasis and may explain in part the lower incidence of IHD in Mediterranean countries where residents consume a diet high in monounsaturated fatty acid. Finally, certain fruits and vegetables such as soy, garlic, and purple grapes may have antithrombotic effects, which may in part be due to the phytochemicals in these foods. Although this review suggests that a plant-based diet with sufficient n-3 fatty acids and certain fruits and vegetables may have a favorable impact on hemostasis and thrombosis, the evidence is neither sufficient nor conclusive at this time to warrant specific recommendations for the public. Clearly, much remains to be done in this area of investigation.