VTE is one of the most serious complications following total hip and knee arthroplasty, and remains a genuine threat to the life of a patient. This article summarizes guidelines for preventing VTE after total hip and knee arthroplasties in the U.S., Europe, and Japan. Since 2007, the use of Fondaparinux and Enoxaparin has been permitted under Japanese insurance. We can use anticoagulant drugs in the same way as they are used in the U.S. and Europe. For this reason, the Japanese Orthopaedic Association published a revised edition of its Guidelines for Preventing VTE in 2008. For patients undergoing elective THA and TKA, active movement of the ankle and early ambulation are important principles. As specific mechanical methods of thromboprophylaxis, which include graduated compression stockings, intermittent pneumatic compression devices and venous foot pump, increase the venous outflow and reduce stasis within leg veins, mechanical methods are recommended for these patients. The use of one of the following anticoagulant options is recommended for these patients with clinical risk factors: Enoxaparin, Fondaparinux, and Warfarin. Clinical risk factors include previous VTE, congenital and acquired thrombophilic disorders, prolonged immobility, and paralysis. The use of anticoagulant drugs in all patients with total joint arthroplasty is, however, still controversial, so we must use these drugs, while considering their risks and benefits. We demonstrated the protocols of the prevention of VTE after total hip and knee arthroplasty in our hospital. In this study of consecutive 398 total hip and knee arthroplasties from August in 2007 to July in 2008, the overall prevalence of VTE in THA and TKA was 7.7%, and 36.4% with having a symptomatic VTE rate of 0%, and 1.0%, respectively. There was no occurrence of pulmonary embolism within one year.