Venous thromboembolism (VTE) remains a major problem that increases morbidity, mortality and health costs in hip and knee replacement surgery, major bone fractures and oncologic surgery which emerges during the perioperative period and is a preventable perioperative complication. Surgeons have been trying to avoid this complication for a long period of time. The mechanism must be understood clearly in order to avoid this complication. Although major steps have been taken in defining the complex pathogenesis of VTE in recent years, the mechanism has not been explained yet. Therefore, current prophylaxis guidelines fail to prevent this complication.