In the last decade, the performance of an adequate perioperative prophylaxis for venous thromboembolism (VTE) has become an established in-hospital measure. Although new antithrombotic drugs (oral thrombin inhibitors, fondaparinux) could reduce the incidence of perioperative VTE, the absolute number remains high. In contrast to the widely accepted in-hospital perioperative prophylaxis, it is still unclear whether prophylaxis has to be prolonged after the hospital stay ("out-of-hospital prophylaxis"). In this review, we will demonstrate by evaluation of recent studies and recommendations that a prolonged out-of-hospital prophylaxis for venous thromboembolism can further reduce the incidence of VTE after surgery, mainly orthopaedic surgery, e.g., endoprothetic joint replacement. At present low-molecular-weight heparins (LMWH) may be most effective and exhibit a low risk for major bleeding. Similar studies with other antithrombotics and other types of surgery are still missing. Finally, the medico-legal aspects concerning postoperative in-hospital and extended prophylaxis are discussed.