OBJECTIVES: The risk of VTE after hip fracture surgery has been clearly demonstrated by randomized clinical trials designed for the registration of a new anti-thrombotic agent. Nevertheless as the diagnosis of VTE was based on a systematic venography which is not routinely performed in current practice, real life data based on the occurence of clinical events are needed from both an epidemiological and economic point of view. METHODS: The VEEP (VEnous Embolism in hiP fracture) cohort study was a prospective cohort study run in two big French public hospitals. During a one-year period, patients hospitalized for hip fracture were consecutively included and followed up for three months. Resource use data concerning type of surgery, anti-thrombotic treatments (preventive, curative) and clinical events (Deep Vein Thrombosis, Pulmonary Embolism, bleedings) were collected. RESULTS: One hundred sixty-nine patients were included in the cohort study (mean age 84.6 years, 82% female). History of previous VTE was found in 15% of the patients. Mean length of stay in acute care was 16.1 days (+/- 11). Mean length of stay in rehabilitation unit was 41.6 days (+/-22.7). A total of 162 patients received an antithrombotic treatment post-operatively (in most of cases a low molecular weight heparin). The cumulative rate of VTE clinically suspected and confirmed by echo-doppler was higher than expected (13.6% at three months) and 80% of the VTE events occur after discharge from acute care. Only one pulmonary embolism was reported. Length of stay was significantly higher in patients having experienced a VTE (nine additional days on an average) leading to substantial additional costs. CONCLUSION: Despite standard antithrombotic prophylaxis the risk of clinical VTE is high after hip fracture surgery and even higher after the acute phase, highlighting the need for more effective preventive therapies.