Advancement in medical technology has increased the life expectancy of people, leading to a significant rise in geriatric fractures. Hip fracture in particular is in rise with associated high morbidity and mortality. Venous thromboembolism and perioperative anemia due to blood loss or chronic conditions are major complications influencing patient outcomes. Though thromboprophylaxis and blood transfusion practices have evolved significantly, there still persist debates regarding the most effective management strategies. In major part across the world, Low-molecular-weight heparin remains the standard for venous thromboembolism prophylaxis, however direct oral anticoagulants are increasingly being investigated and used in orthopedic trauma. Restrictive transfusion strategies have shown safety and potential benefits in reducing complications. However, individual patient factors play major role in their subsequent management. Thromboprophylaxis and transfusion strategies in hip fracture surgery should be individualized as per the patient and institutional protocol for optimization. Emerging data support broader use of DOAC as per the protocol practice. The restrictive targeted transfusion remains safe in most patients. Future research should clarify optimal protocol in high-risk population. This article aims to discuss current evidence and guidelines regarding thromboprophylaxis and blood transfusion in hip fracture surgery and highlight recent advances and ongoing challenges.