Hypercoagulability contributes to atherosclerosis (AS) progression in individuals suffering from rheumatoid arthritis (RA), and thromboelastography (TEG) is a valuable diagnostic tool. This hospital-based cross-sectional study assessed the clinical efficacy of TEG parameters in detecting hypercoagulability and subclinical AS by purposively sampling 372 RA patients and 105 healthy controls. TEG indices, conventional coagulation markers, and biochemical profiles were assessed. Multivariable logistic modeling and receiver operating characteristic (ROC) analyses were utilized to identify independent risk factors for early AS in patients with RA. Our results indicated that patients with RA experienced a hypercoagulable state in comparison to controls, which was particularly pronounced in RA patients with early AS compared to their non-AS counterparts. Logistic regression analysis revealed that the TEG maximum amplitude (MA) is an independent risk factor for early AS in patients with RA, with an odds ratio of 1.219 and a 95% confidence interval of 1.128-1.317. Additional independent risk factors identified are fibrinogen (FIB), low-density lipoprotein cholesterol (LDL-C), and the adjusted atherogenic index of plasma (aAIP). ROC analysis revealed that MA achieved an area under the curve (AUC) of 0.711 (sensitivity: 71.5%; specificity: 63.5%) for early AS diagnosis. Combining with FIB, LDL-C, and aAIP significantly enhanced diagnostic performance, with an AUC of 0.831 (sensitivity: 77.6%; specificity: 75.3%). These findings highlight MA as a valuable biomarker for early detection of AS in patients with RA. Furthermore, integrating MA with FIB, LDL-C, and aAIP improves diagnostic accuracy, supporting its clinical role in risk stratification and early intervention.