To compare the results of postoperative venous thromboembolism prophylaxis with low molecular weight heparin (LMWH) and rivaroxaban. Subjects and methods: The study was design retrospectively, 30,010 surgical patients with >18 years of age were recruited f-rom January 1, 2017 to September 31, 2018 to received anticoagulation with LMWH or rivaroxaban. Of these, 25.479 patients were prevented by LMWH and 4.531 patients were prevented by rivaroxaban. Result: The number of postoperative VTE patient accounting for 0,6% in LMWH group (146/25479), which was higher than the figure of rivaroxaban group of 0,3% (15/4531) and the proportion of patients developing VTE in 90 days after hospital disc-harge of the LMWH group was 0,5% (138/25479), compared to rivaroxaban group with percentage of 0,3% (14/4531).The rate of developing bleeding complications were higher in LMWH prophylactic group with 6,2% (1585/25479) in comparison with rivaroxaban group with 4,5% (206/4531). The difference was statistically significant with p < 0.05. Conclusion: Rivaroxaban reduced the rate of VTE recurrence and did not increase the risk of bleeding complication in postoperative patients compared with LMWH, the difference was statistically significant.