Background: Twin reversed arterial perfusion (TRAP) sequence is a rare anomaly of monochorionic twins involving artery-to-artery anastomoses resulting in a structurally normal "pump" twin that provides circulation to an acardiac twin in a retrograde fashion.Case: Herein we report a rare case of a triplet gestation (TrGA) consisting of two conjoined acardiac TRAP recipients and one surviving normal pump fetus. The TRAP recipients were discordant for their anomalies. We know of only three similar case reports from the literature. Conclusion:Characteristic ultrasound findings allow for the prenatal diagnosis of TRAP sequence and may allow prompt and appropriate treatment to improve the outcome of the pump twin.

Hospital-acquired venous thromboembolism (VTE) incurs significant morbidity and mortality. 1 Chemoprophylaxis is proven to reduce the risk of VTE and is recommended by guidelines. However, chemoprophylaxis increases the risk of bleeding. 2 Therefore, chemoprophylaxis prescription requires balancing the risk of bleeding with thromboembolic protection. Currently, chemoprophylaxis usage is associated with the following issues 3-11 :(1) Guidelines are outdated, unclear or poorly utilized.(2) Compliance is suboptimal, increasing the risk of VTE.(3) The optimal timing of perioperative administration is unclear leading to significant variations in practice. ( 4) The lack of standardization of chemoprophylaxis may adversely affect bleeding and/or VTE risks. The Perioperative Timing of Elective Chemical Thromboprophylaxis in General surgery (PROTECTinG) investigators, through the Victorian collaborative for Education, Research, Innovation, Training and Audit by Surgical trainees (VERITAS) has recently addressed these issues. PROTECTinG has delivered seven

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