OBJECTIVE:To compare the efficacy and safety of low molecular weight heparin and rivaroxaban in the preven-tion of deep venous thrombosis after spinal surgery. METHODS:Totally 276 patients with high risk factors after spinal surgery were randomly divided into control group and observation group. The patients in the two groups were used elastic stockings to physi-cally prevent deep venous thrombosis from the postoperative first day to continue 3 months;based on it,control group was subcuta-neously injected with 1 low molecular weight heparin from the postoperative first day,once a day. Observation group was orally treated with 1 Rivaroxaban tablet,once every night. The treatment course for 2 groups was 2 weeks. The clinic data was observed, including clinical efficacy,superficial femoral vein diameter(FSV),popliteal vein diameter(POPV),prothrombin time(PT),fi-brinogen degradation products(FIB)and D- dimer(DD)before and after treatment,incidence of deep venous thrombosis and ad-verse reactions. RESULTS:There were no significant differences in the total effective rate and deep venous thrombosis and inci-dence of ADR between 2 groups(P>0.05). After 3 months,compared with before,there were no significant differences in the FSV and POPV between 2 groups (P>0.05);POPV in control group was significantly lower than before and observation group, there was statistical significance(P<0.05). After 1 week,compared with before,there was no significant difference in the PT be-tween 2 groups(P>0.05);the FIB and D-D were significantly higher than before,there was statistical significance(P<0.05), however,there were no significant differences between 2 groups(P>0.05);after 4 weeks,PT in 2 groups was significantly high-er than before,there was statistical significance(P<0.05),however,there were no significant differences between 2 groups(P>0.05);FIB and D-D were significantly higher than before,and observation group was lower than control group,there was statisti-cal significance(P<0.05). CONCLUSIONS:Both efficacy and safety of low molecular weight heparin and rivaroxaban in the pre-vention of deep venous thrombosis after spinal surgery are good. However,rivaroxaban is better than low molecular weight heparin in improving blood coagulation function.