With the acceleration of population aging, elective tension-free inguinal hernia repair in patients on long-term antithrombotic drugs has become a common clinical scenario. During the treatment of such patients, hernia surgeons often find themselves in a dilemma due to the high risk of thrombosis associated with drug discontinuation and the high risk of bleeding associated with continued medication. Elective inguinal hernia repair is generally classified as a low to moderate bleeding risk procedure both domestically and internationally, laying a safety foundation for the continued use of some antithrombotic drugs. However, clinical decision-making still requires individualized trade-offs based on patient thromboembolic risk, surgical bleeding risk, and drug characteristics. This article draws on domestic and international guidelines, consensus statements, original studies, and reviews concerning perioperative antithrombotic management in non-cardiac surgery and inguinal hernia repair. It systematically describes the perioperative management of aspirin, P2Y12 inhibitors, warfarin, and direct oral anticoagulants in inguinal hernia surgery, covering risk stratification, selection strategies, bridging timing, procedure selection, and day surgery models. The goal is to provide hernia surgeons with actionable evidence-based guidance