One of the complications of injuries due to the orthopedic manipulation is the development of venous thromboembolism. This article represents data from a study whose purpose was to conduct a comparative assessment of the effectiveness of rivaroxaban and enoxaparin for the prevention of thrombosis in patients after the blocked intramedullary nailing (BIOS), as well as to assess the patients’ adherence to anticoagulant therapy. In a prospective study we examined the results of the treatment of 98 patients with fractures of the tibia or femur. The two groups of patients were assigned to thromboprophylaxis with rivaroxaban (58 patients), 10 mg once daily or enoxaparin (40 patients), 40 mg once a day. The effectiveness criteria of the therapy were diagnosed venous thromboembolisms. Adherence to treatment was assessed as the proportions of patients adhere to prescribed drug regimen. Venous thromboembolic events were observed in two patients (2%) (one per group of rivaroxaban and enoxaparin), p>0.05. Assessment of adherence: in the rivaroxaban group 47 (81%) patients were adherent, in the enoxaparin group — 6 patients (15%), p<0.05. This study demonstrates that in clinical practice rivaroxaban can be an effective alternative to low molecular weight heparin to prevent thrombosis in patients after the conducted BIOS. Patients adherence of oral anticoagulant therapy significantly higher.