Two hundred twenty patients undergoing degenerative spine surgery were randomized to receive either enoxaparin 40 mg subcutaneously once daily (n=110) or rivaroxaban 10 mg orally once daily (n=110). The primary outcome was the incidence of venous thromboembolism (VTE) (DVT and PE). Secondary outcomes included reoperation rate, length of hospital stay, surgical site infection, CSF leakage, and other complications. Outcomes were assessed at 2 weeks and 3 months postoperatively. Overall, the results of the study revealed that rivaroxaban was non-inferior to enoxaparin for VTE prevention, with significantly lower reoperation rates and shorter hospital stays. These findings suggest that rivaroxaban may be a safe and effective alternative to enoxaparin for thromboprophylaxis in this setting.