BACKGROUND Perioperative venous thromboembolism remains a major health problem. Each year, approximately 260,000 cases are diagnosed clinically, and the incidence of asymptomatic and undiagnosed cases is far greater. Despite the availability of effective strategies to prevent venous thromboembolism, prophylaxis is underutilized. According to recent epidemiologic surveys, approximately two thirds of hospitalized patients with clinical risk factors for venous thromboembolism do not receive adequate prophylaxis. METHODS A comprehensive review of the English language literature was carried out to define effective antithrombotic regimens to prevent venous thromboembolism in discrete surgical patient populations. Reliable data are available for every group with the exception of patients with multiple trauma and spinal cord injury. CONCLUSIONS A wide variety of effective prophylactic methods are available to prevent venous thromboembolism. Individual patients can be assigned a level of risk based on clinical risk factors. The choice of prophylactic method is based on the level of risk, potential for complications, and costs. With the wide availability of proven methods, no patient at risk for venous thromboembolism should be left unprotected.