Venous thromboembolism is a fairly common complication in the perioperative period. Some risk factors are inherited and are more common than previously thought. Anesthesiologists must carefully evaluate a patient's current regimen for DVT prophylaxis when considering the risks and benefits of neuraxial blockade. Despite exciting diagnostic modalities for deep vein thrombosis and pulmonary embolism, the diagnosis often goes unrecognized. The optimal diagnostic strategy remains debatable. Because the disease is often silent in nature and because fatal pulmonary embolism may be its first manifestation, adequate prophylaxis is the only reasonable management strategy. Unfortunately, it is often inadequate or underused.