This study found that the use of pharmacologic anticoagulation was never deemed rarely appropriate, implying that these medications should always be considered in the post operative management of patients undergoing spine surgery. In certain cases, particularly for patients with spinal cord injury or increased VTE risk factors, the question appears to be not whether VTE prophylaxis should be initiated, but when. Controversy remains regarding the optimal timing for starting chemical prophylaxis, especially within the first 24 hours postsurgery. The primary concerns revolve around the risk of bleeding complications, which, although rare, can range from minor to severe. As a result, clinicians must make a careful and balanced decision for each patient, weighing the risks of VTE against the risks of bleeding. While VTE prophylaxis reduces the incidence of VTE, uncertainty remains for certain patient groups due to their individual risk profiles.