OBJECTIVE： To compare the effectiveness and safety of low-molecular-weight-heparin （LMWH） calcium and rivaroxaban in preventing lower extremity deep venous thrombosis （DVT） in the elderly patients after surgery of replacement of fracture. METHODS： A total of 58 elderly patients underwent hip or artificial femoral head replacement were randomly divided into LMWH group （29 cases） and Rivaroxaban group （29 cases）. All patients received basic prevention and physical prevention for DVT after surgery. Based on this， LMWH group was given Heparin calcium injection 4 100 IU subcutaneously 10 h after surgery， for 10 d. Rivaroxabar group was given Rivaroxaban tablet 10 mg 10 h after surgery， once a day， for consecutive 10 d. The occurrence of DVT and positive D-dimer were observed in 2 groups after surgery. The PT， APTT， TT， FIB and platelet counts abnormality were also observed in 2 groups. RESULTS： There was no statistical significance in the incidence of DVT， the occarrence of positive D-dimer， PT， APTT， TT， FIB and platelet counts abnormality 4， 10 d after surgery between 2 groups（P＞0.05）. CONCLUSIONS： LMWH and rivaroxaban both can be used for lower extremity DVT in the elderly patients after replacement of fracture surgery of and have similar therapeutic efficacy and safety.