Objective: To investigate the intervention effects of Chinese herbal hot compress packets combined with graduated compression stockings on the incidence of postoperative deep vein thrombosis(DVT) and lower extremity swelling in elderly patients with hip fractures. Methods: A retrospective cohort study design was employed. Elderly patients with hip fractures admitted from January 2024 to January 2025 were selected and matched 1:1 using propensity score matching, resulting in 34 patients in each of the control and observation groups. The control group received routine nursing care combined with graduated compression stockings, while the observation group received additional external application of Chinese herbal hot compress packets on the basis of the control group. The two groups were compared in terms of DVT incidence at 14 d postoperatively, degree of lower extremity swelling, duration of swelling resolution, coagulation function parameters, and D-dimer levels. Repeated-measures analysis of variance was used to compare the temporal trends of D-dimer levels between the two groups, and multivariate Logistic regression analysis was performed to identify independent influencing factors for DVT. Results: The incidence of DVT at 14 d postoperatively in the observation group was significantly lower than that in the control group(5.88% vs. 26.47%, P=0.021). At 7 and 14 d postoperatively, the affected-side calf circumference and thigh circumference in the observation group were significantly smaller than those in the control group(all P<0.05), and the duration of swelling resolution was shorter in the observation group(P<0.001). The changes in prothrombin time(PT) and activated partial thromboplastin time(APTT) were greater, while the changes in fibrinogen(FIB) and D-dimer levels were lower in the observation group compared with the control group(P<0.05). Repeated-measures analysis of variance revealed statistically significant time effects(F=42.568, P<0.001), group effects(F=28.734, P<0.001), and interaction effects(F=6.892, P=0.002) for D-dimer levels. Between-group comparisons showed that D-dimer levels in the observation group were significantly lower than those in the control group at 3, 7, and 14 d postoperatively(P<0.05). Within-group comparisons indicated that the D-dimer level at 14 d postoperatively did not differ significantly from the preoperative level in the observation group(P=0.058), whereas it remained significantly higher than the preoperative level in the control group(P<0.001), suggesting faster recovery of coagulation function in the observation group. Multivariate Logistic regression analysis identified the combined intervention of Chinese herbal hot compress packets as an independent protective factor against DVT(OR=0.21, 95%CI 0.05-0.89, P=0.034). Conclusion: The combination of Chinese herbal hot compress packets and graduated compression stockings can effectively reduce the incidence of postoperative DVT, alleviate lower extremity swelling, and regulate coagulation function and D-dimer levels in elderly patients with hip fractures, without increasing bleeding risk, demonstrating promising clinical application value.