Objective To investigate the risk factors for venous thromboembolism (VTE) during hospitalization in elderly patients after hip fracture surgery and to evaluate the predictive value of the Caprini score and coagulation molecular markers for VTE. Methods This retrospective cohort study included 516 elderly patients who underwent hip fracture surgery at Huabei Medical Health Group Fengfeng General Hospital between July 2024 and July 2025. Among them, 92 patients developed VTE postoperatively (VTE group), and 424 did not (non-VTE group). Demographic characteristics, fracture type, surgery duration, comorbidities (e.g., hypertension, diabetes), and coagulation markers (D-dimer, TAT, PIC, etc.) measured on postoperative day 3 were recorded. The Caprini risk assessment scale was used to score thrombosis risk at admission. Univariate analysis and multivariate logistic regression identified independent risk factors for VTE, and ROC curves evaluated the predictive efficacy of the indicators. Results Univariate analysis: The VTE group had a significantly higher Caprini score (12.23 ± 1.88 vs. 11.29 ± 1.52) and longer surgery duration (70.75 ± 20.31 min vs. 65.22 ± 15.38 min) (all P < 0.05). Coagulation markers: D-dimer and TAT levels were significantly elevated in the VTE group (P < 0.05), while APTT, PT, and FIB showed no significant differences. Multivariate logistic regression: Caprini score (OR = 1.20), D-dimer (OR = 1.21), TAT (OR = 1.09), and PIC (OR = 1.61) were independent risk factors for VTE (all P < 0.05). Predictive efficacy: The combination of Caprini score, D-dimer, and TAT yielded an AUC of 0.71 (95% CI: 0.68–0.82) in ROC analysis, significantly outperforming individual indicators. Conclusion The Caprini score, D-dimer, and coagulation molecular markers (TAT, PIC) are independent predictors of VTE in elderly patients after hip fracture surgery. Combined use of these indicators can effectively identify high-risk patients and provide a basis for early intervention.