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Guidelines recommend thromboprophylaxis for at least 10 days to prevent venous thromboembolism in patients undergoing high-risk orthopedic surgery, such as total hip arthroplasty (THA) or total knee arthroplasty (TKA). Furthermore, the recently updated ACCP guidelines also recommend extending the duration of thromboprophylaxis for 28 to 35 days following THA or hip fracture surgery as the risk for venous thromboembolism persists for up to 3 months after surgery. Extended-duration thromboprophylaxis (up to 6 weeks) with low-molecular-weight heparin is significantly more effective in preventing venous thromboembolism in orthopedic surgery patients than the recommended practice of at least 10 days. Extended-duration thromboprophylaxis may require risk stratification to identify high-risk patients. Current risk-assessment models have limitations and are not specific to orthopedic surgery patients; therefore, improvements may facilitate the use of extended-duration thromboprophylaxis in high-risk patients, thereby reducing the burden of venous thromboembolism. Venous thromboembolism, including both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important complication of major orthopedic surgery, and is associated with significant morbidity and mortality.1 Current data suggest that, in the absence of thromboprophylaxis, venographically documented DVT occurs in approximately 50% of patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA), and fatal PE may occur in up to 1.7% of patients undergoing TKA and up to 2% of those undergoing THA (Table 1). Approximately half of all cases of DVT after orthopedic surgery involve proximal leg veins.1,3 Therefore, patients undergoing major orthopedic surgery, such as TKA or THA, are at high risk or very high risk of venous thromboembolism; hence, current management guidelines recommend that thromboprophylaxis should be used routinely in such patients.2,3 Story continues below↓