Abstract Tuberculosis (TB) patients who develop venous thromboembolism (VTE) have poor clinical outcomes. This study aimed to explore the risk factors and the prognosis of TB patients with VTE. A total of 11 267 with TB patients from the Zhejiang University‐affiliated Chest Hospital, China, were enrolled between January 2016 and January 2020. A total of 107 TB patients with VTE were selected as the VTE group. Patients in the control group were randomly screened in a 1:1 ratio between the VTE and control groups. Univariate and multivariate logistic regression analysis was used to evaluate the factors associated with VTE in TB patients. Of the 214 patients, 145 (60.17%) were male, 69 (32.2%) were female, with an average age of 62.21 ± 19.35. The incidence of VTE in TB patients was 0.95%. Using a univariate analysis, it was found that age, fever, dyspnea, lower limb edema, respiratory failure, malignant tumor, prothrombin time, activated partial thromboplastin time, D—dimer, and hemoglobin levels were different between the two groups (P < 0.05). Multivariate logistic regression analysis showed that higher D‐dimer value, higher incidence of lower limb edema, and TB were risk factors for VTE; OR (95%CI) = 8.840 (2.383–32.794); OR (95%CI) = 4.957 (1.219–20.161); OR (95%CI) = 16.216 (4.779–55.025). However, the use of Rifamycin was found to be a protective factor against VTE [OR (95%CI) = 0.170(0.073–0.395)]. Receiver operating characteristic curve (ROC) curve of D‐dimer (area under curve [AUC] = 0.831 ± 0.028 [95%CI: 0.776–0.886, P < 0.05]) and the cut‐off value of 1855 μg/L was obtained according to the Youden index, with a sensitivity and a specificity rate of 82.2% and 74.3%, respectively. The risks of VTE seem higher in TB patients with fever, dyspnea, lower limb edema, and D‐dimer levels of more than 1855 μg/L; therefore, it should be actively screened, and prophylactic anticoagulation given if necessary. Effective directly observed treatment plus short‐course chemotherapy (DOTS) protocol anti‐TB therapy helps reduce the probability of VTE in TB patients.