The risk factors for venous thromboembolism (VTE) during hospitalization after hip fracture surgery in elderly patients were investigated. The predictive values of the Caprini score and thrombus molecular markers for VTE were evaluated. A retrospective cohort design was adopted. A total of 516 elderly patients undergoing hip fracture surgery were enrolled. These patients were admitted to Fengfeng General Hospital of North China Medical and Health Group from July 2024 to July 2025. Among them, 92 patients developed VTE postoperatively (VTE group), and 424 patients did not develop VTE (non-VTE group). Demographic characteristics, fracture types, operation times, and concomitant diseases (e.g., hypertension, diabetes) were recorded. D-dimer, thrombin-antithrombin complex (TAT), and plasmin-antiplasmin complex (PIC) were measured on the third postoperative day. The Caprini risk assessment scale was utilized to assess thrombotic risk upon admission. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for VTE. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive efficacy of each indicator. Univariate analysis shows that the Caprini score in the VTE group (12.23 ± 1.88) is significantly higher than that in the non-VTE group (11.29 ± 1.52). Operation time is longer in the VTE group[(70.75 ± 20.31) min vs. (65.22 ± 15.38) min, both P<0.05]. Thrombus molecular markers show significant elevations in the VTE group, including D-dimer and TAT levels (P<0.05). No significant differences are observed in APTT, PT, or FIB levels between the two groups. Multivariate logistic regression demonstrates that the Caprini score (OR=1.20), D-dimer (OR=1.21), TAT (OR=1.09), and PIC (OR=1.61) are independent risk factors for VTE (all P<0.05). The area under the ROC curve for the combination of Caprini score, D-dimer, and TAT is 0.71 (95% CI: 0.68~0.82). The combined predictive model (TAT+5.33PIC+2.11DD+2.00) exhibits significantly superior performance compared to single indicators. Caprini score, D-dimer, and thrombus molecular markers (TAT, PIC) are confirmed as independent predictors of postoperative VTE in elderly patients with hip fractures. The combined application of these indicators effectively identifies high-risk patients and provides a basis for early intervention.