Fibrosis is a pathological healing process which occurs in the progression of various chronic diseases after tissue injury. Extracellular vesicles are involved in tissue fibrosis through communication between cells. Macrophages are important immune cells that maintain tissue integrity by eliminating or repairing damaged cells and matrix. Macrophages can directly regulate tissue fibrosis by secreting extracellular vesicles and transporting microRNAs, lncRNAs and fibrogenic factors to target cells of lungs, heart, liver, kidney and other organs. At the same time, chronic diseases are often accompanied by inflammation. A large number of macrophages are recruited to the site of injury, and local or distal cells transport extracellular vesicles to macrophages to regulate the polarization of macrophages, thus affecting the development and prognosis of tissue fibrosis.