The study's purpose was to determine if there is an association between ABO blood group and the development of symptomatic venous thromboembolism (VTE) after total joint arthroplasty (TJA).A total of 28,025 patients who underwent primary TJA at a single health care system from 2000 to 2014 were retrospectively reviewed from electronic records. Patients who experienced a symptomatic VTE were identified. A multivariate regression model adjusted for known potential risk factors, including age, gender, body mass index, surgery type, previous VTE, smokers, rheumatologic diseases, malignancy, hypercoagulable state, and VTE prophylaxis, was developed to test the association of ABO blood group and postoperative VTE. Separate multivariate regressions were performed for total knee arthroplasty and total hip arthroplasty, specifically looking at pulmonary embolism.The risk of symptomatic VTE after TJA was increased in AB blood group patients (odds ratio = 1.4; P = .03). Furthermore, the risk of pulmonary embolism was increased after total knee arthroplasty in AB blood group patients (odds ratio = 2.24; P = .001) but not after total hip arthroplasty (P = .742).AB blood group increased the risk of VTE after TJA. Patient's ABO blood group should be considered in terms of risk stratification and selection of appropriate postoperative VTE prophylaxis.