Abstract: Objective To investigate the influencing factors of deep vein thrombosis (DVT) of the lower extremity after total hip arthroplasty (THA) by analyzing perioperative thromboelastography (TEG), conventional coagulation tests (CCTs), and other clinical parameters.Methods A retrospective analysis was conducted on the clinical data of patients who underwent primary unilateral THA in Department of Orthopedics, Changshu First People's Hospital from June 2019 to December 2022. A total of 120 patients were included according to inclusion and exclusion criteria. Based on postoperative color Doppler ultrasound results of the lower extremity, the patients were divided into two groups: DVT and non-DVT. Their data were collected, including gender, age, body mass index (BMI), smoking history, alcohol history, chronic diseases (hypertension, diabetes, and coronary atherosclerotic heart disease), TEG and CCT results one day before and after surgery, complete blood counts, as well as intraoperative information such as surgical duration, blood loss, transfusion volume, transfusion rate, and postoperative drainage. The incidence of DVT after THA was calculated, and univariate and multivariate logistic regression analyses were performed to identify factors influencing DVT development.Results Univariate analysis revealed that on pre-operative day 1, the DVT group showed significantly higher levels of D-dimer, fibrin degradation products (FDP), α angle, maximum amplitude (MA), and coagulation index (CI), and a significantly shorter reaction time (R), than the non-DVT group (P<0.05). On post-operative day 1, D-dimer and MA were significantly higher, and R was significantly shorter in the DVT group (P<0.05). Multivariate logistic regression identified that R and CI on pre-operative day 1, as well as D-dimer and R on post-operative day 1, were independent influencing factors for the development of DVT.Conclusions R and CI on pre-operative day 1, and D-dimer and R on post-operative day 1, are factors influencing the occurrence of DVT following THA. Specifically, longer R values one day before and after surgery, and lower CI on pre-operative day 1, are protective factors, whereas elevated D-dimer on post-operative day 1 is a risk factor for DVT.