Abstract: Objective To study the expression and predictive value of macrophage inflammatory protein-1α (MIP-1α) and D-dimer / fibrinogen (DFR) ratio in elderly patients with venous thromboembolism (VTE). Methods A total of 129 suspected VTE patients over 65 years of old were enrolled in the study. According to compression ultrasonography (CUS) and CT pulmonary angiography (CTPA), patients were divided into non-DVT group (n=76), DVT group (n=34) and pulmonary thromboembolism (PTE) group (n=21). Fresh blood samples were collected from patients before the anticoagulant therapy. Data of blood routine test and clotting indicators were collected, and neutrophil count/lymphocyte count ratio (NLR) was calculated. The plasma level of D-dipolymer was measured by immunoturbidimetry. The plasma level of fibrinogen was determined by the solidification method, and DFR ratio was calculated. The expression level of MIP-1α was detected by ELISA, and the expression level of MIP-1α mRNA was detected by real-time PCR. The predicted value of some indicators for VTE was analyzed by plotting ROC curve. Results The levels of D-dimer, age-adjusted D-dimer and DFR were significantly higher in PTE group and DVT group than those in non-DVT group (P＜0.05). There was no significant difference in fibrinogen between the three groups. The serum levels of MIP-1α were significantly higher in DVT group and PTE group than those in non-DVT group, and compared with DVT group, the serum level of MIP-1α was lower in PTE group (P＜0.05). The relative expression of MIP-1α mRNA was significantly higher in DVT group and PTE group than that in nonDVT group (P＜0.05). Levels of D-dimer, age-adjusted D-dimer, DFR, MIP-1α showed certain diagnostic values for elderly VTE, and the diagnostic efficiency of age-adjusted D-dimer (AUC=0.864) was the best one. DFR (AUC=0.853) was comparable to that of the traditional D-dimer (AUC=0.851). The predictive value of MIP-1α (AUC=0.739) for VTE was a common result. NLR showed no diagnostic value for VTE (P＞0.05). Conclusion The age-adjusted D-dimer is an ideal diagnostic marker for the diagnosis of VTE in the elderly. DFR and MIP-1α can be used as a method to diagnose VTE. MIP- 1α may be a new indicator for evaluating venous thrombosis and unstable shedding.