The findings of 70 publications, focusing on total joint replacement (TJR) which used some form of thromboprophylaxis, were combined to assess the effect of throboprophylaxis on mortality and proportion of deaths due to a known or suspected pulmonary embolism (PE) in modern TJR. 99441 patients were categorized into 7 groups based on the type of throboprophylaxis. Death occurred in 373 of the patients analysed; these deaths were then grouped by cause, including cardiopulmonary (excluding PE), pulmonary embolism (PE), bleeding, CNS, gastrointestinal and other. Results indicated that there was a very low mortality rate, regardless of thromboprophylaxis in TJR. The use of potent anti-coagulants (PA) did not reduce the mortality rate or the proportion of deaths due to a known or suspected PE and called in to question their routine use following TJR.