The risk for venous thromboembolism (VTE) in total hip arthroplasty and hip fracture surgery is much higher than that of any other surgery. There is a general agreement that prevention of VTE in hip surgery patients is necessary due to concerns regarding symptomatic deep vein thrombosis or fatal pulmonary embolism. Optimal strategies for prevention of VTE include pharmacologic and mechanical approaches; however, the ideal prophylactic regimen has not been identified. Selection of a prophylactic regimen should be balanced between efficacy and safety. This article discusses the different prophylactic options available today for prevention of VTE in hip surgery patients.