Patients after major orthopedic surgery represent a group that has a particularly high risk for venous thromboembolism (VTE). Pulmonary embolism (PE) is the most frequent reason of lethality. Routine use of thromboprophylaxis (TP) essentially reduces the frequency of this complication. The efficacy and the safety of the local Protocol of TP in surgical patients in Vreden's Russian Research Institute of Traumatology and Orthopaedics was studied. We analyzed the medical cards of 731 patients after hip or knee replacement. Routine use of the TP Protocol was effective: no cases of symptomatic deep venous thrombosis (DVT) in the investigated group during hospitalization, subclinical thrombosis of saphena for 2 patients (0,26 %) was detected by ultrasonography, in one case (0,13 %) was pulmonary embolism of small branches. Epidural hematomas, heparin-associated thrombocytopenia and the major bleedings, which demand cancellation of anticoagulants, were not revealed during the research. This study showed the insufficient use of methods of mechanical VTE prevention (frequency of appointment of graded elastic compression stockings of 37,9%), difficulties with selection of an effective and a safe dose of warfarin. Probably, a more frequent application of mechanical TP and use of the new oral anticoagulants, its administration doesn't require laboratory monitoring and demanding selection of a dose, can raise its efficacy and safety of TP.