Objective To investigate the relationship between the prothrombotic state and leukoaraiosis(LA)in elderly patients with metabolic syndrome.Methods A total of 350 metabolic syndrome patients in the affiliated hospital of Zhejiang University who received treatment from January 2013 to January 2015.According to the results of head MRI,patients were divided into LA group(n=203)and non-LA group(n=147).The severity of LA was graded by its MRI appearance and the Blennow scale.The plasma levels of fibrinogen (Fib),prothrombin time (PT),thrombin time (TT),activated partial blood coagulation time(APTT),D-dimer (D-D) and yon willebrand factor (vWF) were measured and compared between the two groups.Results The levels of Fib,vWF and D-D were higher in LA group than in non-LA group(all P＜0.05).Spearman correlation analysis showed that the severity of leukoaraiosis was positively correlated with Fib,vWF and D-D(r=0.014,0.089,0.215,respectively,all P ＜ 0.05).Multivariate linear regression analysis showed that Fib,course of hypertension,vWF and HbA1c were the main influencing factors with the standardized regression coefficient of 2.516,0.312,0.206 and 0.167 respectively for leukoaraiosis in elderly patients with metabolic syndrome.Conclusions The course of hypertension and HbAlc level are positively related with LA.The prothrombotic state markers including Fib and vWF can be considered as the predictors for LA severity in elderly patients with metabolic syndrome.