Background　The balance between coagulation and fibrinolysis is affected by surgical intervention, aging and nerve tissue in elderly patients undergoing neurosurgical procedure. The use of thrombelastography monitors the perioperative changes of coagulation and fibrinolysis and is beneficial for maintaining normal clotting function.　Objective　This article reviews the effects of surgical procedure, aging and nervous tissue on coagulation and fibrinolysis and the new concept of hemostasis as well as thrombelastography, thenew technology to detect blood coagulation and fibrinolysis.　Content　Disorder of clotting function in elderly neurosurgical patients results in perioperative hypercoagulable state and tendency for thromboembolism. As a new view the cell-based model of hemostasismore accurately describes the molecular mechanisms of hemostatic process in vivo. It also promotes the clinical application of thrombelastography for assessing the function of platelets, coagulation factors and fibrinolysis in blood.　Trend The use of this new technology will effectively prevent perioperative thrombosis or bleeding.