Venous thromboembolism (VTE) is a serious, yet preventable complication associated with significant morbidity and mortality [1,2]. It is defined as the formation of a deep vein thrombus (DVT), which can then dislodge and travel to the lungs resulting in pulmonary or brain embolism in patients with patent foramen ovale (PFO) [3]. VTE is the third most prevalent cardiovascular disorder, affecting 1 to 2 per 1000 people yearly [3]. According to the current literature, more than 50% of hospitalized patients are at risk of developing VTE and surgical patients are considered to be at higher risk when compared to medical ones [2].

Virchow's triad (blood flow stasis, vascular endothelial damage and hypercoagulability) summarizes the pathophysiology of VTE [1], [2], [3]. Major surgeries, including orthopaedics, obesity, older age and immobility are some of the well-known risk factors for VTE [1,3]. In major orthopaedic surgery particularly (1) the use of tourniquet, bed rest and immobilization can cause venous stasis, (2) surgical manipulations may lead to endothelial disruption and (3) the use of bone cement promotes hypercoagulability, while (4) in cases of trauma circulating thromboplastin agents and the risk of a hypercoagulable state are further increased [2]. Thus, without VTE prophylaxis the overall incidence of VTE in orthopaedic procedures may be as high as 60% [2].

However, when routine prophylaxis is implemented according to published guidelines, fatal pulmonary embolism is uncommon, and the rates of symptomatic VTE are <10% [2]. Therefore, in patients undergoing orthopaedic procedures, adherence to updated guidelines regarding VTE prophylaxis is of paramount importance. To the best of our knowledge, the available recommendations with respect to thromboprophylaxis in patients undergoing orthopaedic procedures have not yet been systematically reviewed and methodologically assessed. The aims of this systematic review were: 1) to identify clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on thromboprophylaxis in adult patients undergoing orthopaedic procedures and 2) to report and assess the reporting clarity and methodological quality of the relevant CPGs and CPRs, using the Appraisal of Guidelines for Research & Evaluation II (AGREE-II) tool [4].