Abstract: Objective：To compare the efficacy and safety between rivaroxaban and traditional anticoagulants in patients over 80 years old with venous thromboembolism. Methods：The clinical data of 45 patients over 80 years old with venous thromboembolism were retrospectively analyzed. Among whom, 28 cases were treated with rivaroxaban (rivaroxaban group), and 17 cases were treated with traditional anticoagulants (low-molecular weight heparin combined with warfarin or low-molecular weight heparin alone; traditional anticoagulation group). The differences of recurrence, bleeding events, deaths, and efficiency were compared between the two groups within 12 months of treatment. Results：There was no statistically significant difference in the baseline data of patients between the two groups. Within 12 months of treatment, there was no statistically significant difference in the rates of recurrence, bleeding events, thrombosis-related deaths, and overall effective rate of anticoagulation between the two groups. The all-cause mortality in the rivaroxaban group and subgroup of tumor patients was lower than that in the traditional anticoagulation group (P<0.05). Conclusions：The safety and efficacy of rivaroxaban and traditional anticoagulants may be similar in patients over 80 years old with venous thromboembolism.