Coronary artery disease (CAD) and Coronavirus disease 2019 (COVID-19) are both associated with a hypercoagulable state, yet the long-term interaction between these prothrombotic conditions remains poorly characterized. This study investigated dynamic changes in coagulation function among COVID-19 survivors with CAD over a two-year follow-up period. A total of 117 CAD patients admitted to Shanghai Pudong Hospital between March and June 2022 were retrospectively enrolled: 60 with confirmed COVID-19 infection (COVID-19 group) and 57 without COVID-19 (control group). Thromboelastography (TEG) and conventional coagulation tests were performed at admission and at one and two years after discharge. Results showed that at one and two years after discharge, the COVID-19 group exhibited a comprehensive TEG profile indicative of a hypercoagulable state-including accelerated clot initiation, rapid propagation, and enhanced clot strength- compared to the control group (P < 0.05). In contrast, no significant between-group differences were observed in conventional coagulation parameters (P > 0.05). Notably, neutrophil levels in the COVID-19 group were significantly elevated at one and two years after discharge (P = 0.0353 and P = 0.0397, respectively) compared to acute-phase levels, while lymphocyte and platelet counts remained stable. Stratified analysis by antithrombotic intensity further revealed that standard antithrombotic regimens did not fully normalize the TEG-defined hypercoagulability in COVID-19 survivors at two-year follow-up. In conclusion, CAD patients with prior COVID-19 infection demonstrate sustained hypercoagulability and elevated neutrophil levels up to two years after discharge. These findings highlight the importance of TEG-based coagulation monitoring and neutrophil surveillance in CAD patients recovering from COVID-19 and support the need for individualized anticoagulation strategies. Future research should validate these findings in larger, multicenter cohorts and explore the underlying mechanisms and potential therapeutic targets.