INTRODUCTION: Venous thromboembolic complications (VTEC) such as deep and subcutaneous vein thrombosis and pulmonary embolism are the most important clinical problems in many specialties. High-risk factors for thrombus formation include surgical interventions leading to the activation of the hemostatic system. Despite the existing international and Russian clinical recommendations on the treatment and prophylaxis of VTEC containing a detailed description of the methods and algorithms of prophylaxis in patients with different nosologies including patients with polymorbidities, the incidence of VTEC remains high. In the scientific community, there is a continuing discussion of the effectiveness of various approaches to VTEC prophylaxis in different clinical groups of patients. Algorithms available prescribe anticoagulants at standard doses and combinations. However, in patients with comorbidities, isolated conservative anticoagulant therapy may be insufficient for effective VTEC prophylaxis. CONCLUSION: Currently, there is a need to improve the algorithms of VTEC prophylaxis in patients with comorbid pathologies to elaborate clear indications for the use of both pharmacological and mechanical prevention methods and their combinations.