Background and Aims In patients receiving long-term antithrombotic prophylaxis who require surgery, the continuation of therapy during perioperative period will raise the risk of surgical bleeding, while the incidence of thromboembolic events will increase after drug discontinuation. For inguinal hernia procedures, there is, at present, no consensus or high-quality evidence regarding the perioperative management of antithrombotic medication. Therefore, this study was designed to observe the safety of performing Lichtenstein hernioplasty in inguinal hernia patients on long-term anticoagulation without antithrombotic treatment withdrawal during the perioperative period, so as to help investigate the strategies for perioperative management of anticoagulation in these patients.Methods Using a prospective cohort design, 18 inguinal hernia patients with moderate or high risk of thromboembolism on long-term anticoagulation admitted to the Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University were consecutively enrolled from November 2018 to February 2022. All patients underwent Lichtenstein hernioplasty under nerve block anesthesia combined with laryngeal mask general anesthesia, without interruption of anticoagulation during the perioperative period. The intra- and postoperative bleeding, visual analog pain score (VAS) on postoperative day (POD) 1, postoperative major cardiac adverse events (MACEs), cerebrovascular complications, incision-related adverse events, hernia recurrence and mortality of the patients were observed and followed up.Results The 18 inguinal hernia patients included 4 cases who had previously undergone heart valve replacement surgery, one case with concomitant atrial fibrillation, 9 cases who had previously undergone coronary stenting, one case who had previously undergone coronary artery bypass grafting, and 3 cases with previous myocardial infarction. Among them, 5 patients received long-term oral warfarin therapy, and 13 patients treated with long-term oral antiplatelet-agent therapy that included aspirin administration in 8 cases, clopidogrel administration in 3 cases, and aspirin plus clopidogrel or indobufen administration in 2 cases. Of the 18 patients, the mean length of hospital stay was (9.61±2.59) d, the mean intraoperative blood loss was (3.77±2.53) mL, and the mean operative duration was (70.13±13.44) min. After surgery, one patient had obvious wound bruising, one patient had mild wound bruising, and 16 patients had no obvious wound bleeding. Blood transfusion or reoperation was required in none of them. The median VAS was 1.72 on POD 1. There was no MACEs and cerebrovascular complications occurred during perioperative period. All patients were discharged from the hospital 15 d after surgery. The median follow-up time after discharge was 19.34 months, and the follow-up rate was 100%. No wound-related adverse events, hernia recurrence, MACEs, cerebrovascular complications, and death occurred during follow-up.Conclusion For inguinal hernia patients with moderate or high thromboembolic risk, the strategy of continuous use of antithrombotic drugs during the perioperative period of Lichtenstein hernia repair is safe and feasible on the premise of a comprehensive perioperative management. So, it is recommended as an appropriate choice for application.