This review outlines the current understanding of the interactions of titanium and its alloys with blood components, and the ways in which surface modification techniques can be used to alter the surface physicochemical and topographical features that determine blood-material interactions. Surface modification of the spontaneously formed titanium oxide surface layer is a highly attractive means of improving haemocompatibility without forgoing the advantageous mechanical and physical properties of titanium and its alloys. A number of surface modification techniques and treatment processes are discussed in the context of enhancing the haemocompatibility of titanium and its alloys, with a view to optimising the clinical efficacy of blood-contacting devices and materials.