Due to the degradation of physical function and the gradual decrease of self‑repair ability in elderly patients, the incidences of perioperative complications, especially those related to coagulation function and stroke are still very high. This paper reviews the characteristics of coagulation in elderly patients, the effects of perioperative injury, acidosis, hypothermia, blood transfusion and posture on blood coagulation mechanism in orthopedic surgery, and the measures to prevent deep venous thrombosis in orthopedic surgery, the relationship between fracture and stroke in elderly patients and the relationship between thrombus prevention and anesthesia in orthopedic surgery. It is suggested that during when thrombotic prevention with anticoagulants, clinical doctors should fully weigh the advantages and disadvantages of thrombotic prevention and the risk of bleeding, and choose appropriate anticoagulant regimens to minimize the occurrence of thrombotic diseases, bleeding and other related events, so as to reduce the perioperative complications and adverse events caused by such diseases.