In this expert commentary, Dr Warwick discusses the timing of VTE prophylaxis administration for orthopedic surgeries. He discusses the numerous implications that are associated with assessing a patient’s risk for developing thrombosis after surgery. He also addresses thromboprophylaxis of surgical patients with regard to balancing efficacy versus risk of bleeding. This expert commentary is a thorough overview of how the health care industry is changing the management of VTE prophylaxis following orthopedic surgery. Dr Warwick gives detailed explanations of the issues that physicians are faced with in the initiation and duration of prophylaxis against VTE in hip and knee surgery patients.