Abstract: This article reports the perioperative anticoagulation management of a patient with multiple traumatic fractures and renal contusion who developed new-onset venous thromboembolism(VTE). It investigates holistic anticoagulation strategies for trauma patients with acute massive hemorrhage and high VTE risk throughout the perioperative phase. Using anticoagulation therapy as the cornerstone, we closely monitored thrombotic/hemorrhagic symptoms and coagulation parameters to dynamically optimize the anticoagulation regimen, from initial VTE prophylaxis to post-diagnosis therapeutic intervention. This approach successfully controlled thrombotic progression while minimizing bleeding risk, with no uncontrollable hemorrhage occurring during treatment. Furthermore, this work analyzes perioperative VTE risk factors in such patients and provides critical insights for anticoagulation protocols in trauma-related VTE prevention and treatment, offering valuable lessons for clinical practice enhancement.