Weibel-Palade bodies (WPBs) are endothelial granules that store von Willebrand factor (VWF), P-selectin, and other vascular modulators. Endothelial cells secrete WPBs in response to vascular injury, releasing VWF, which triggers platelet rolling, and externalizing P-selectin, which activates leukocyte trafficking. Endothelial exocytosis is one of the earliest responses to vascular damage and plays a pivotal role in thrombosis and inflammation. This review examines the regulation of WPB exocytosis-the exocytic machinery, activators, and inhibitors of exocytosis-and speculates about the development of novel anti-exocytic drugs.