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Summary: As about 50 % of patients with unprovoked venous thromboembolism (VTE) will develop new episodes after discontinuing therapy, indefi nite treatment is suggested in patients with low or moderate bleeding risk. Baseline and post-baseline factors can help clinicians to identify patients at high risk of recurrence, who require extended treatment. Residual vein obstruction and D-dimer assay have been shown to be suitable methods for assessing the risk of VTE recurrences after a fi rst unprovoked VTE. In treatment for VTE the use of direct oral anticoagulants (DOAC) is growing instead of the standard adjusted dose of vitamin K antagonists. The DOAC safety profi le has recently been strengthened with systematic reviews and metaanalyses. Idarucizumab is only approved for the reversal of dabigatran etexilate; intravenous antidotes for factor Xa inhibitors are under development. Their advent is of great interest. In the extended treatment of VTE sulodexide has been demonstrated to signifi cantly decrease the risk of recurrences with an excellent safety profi le. Aspirin is substantially less effective than oral anticoagulants in preventing recurrences but could play a role among patients who decided to stop anticoagulants. In conclusion, for the secondary prevention of VTE several options are available, without a recognised best choice regarding the treatment duration and the choice of drugs. An individual strategy taking into account risk of recurrence, bleeding risk, therapeutic options, and patient preferences is appropriate.Keywords: Venous thromboembolism, anticoagulation, thrombophilia, recurrence, major bleeding, fatal bleeding especially common after unprovoked VTE episodes; although the highest risk of recurrence is observed in the fi rst six months following the acute event, it remains quite relevant for a longer time. The cumulative ten-year incidence of recurrences after anticoagulant withdrawal approaches 40 % among all patients with VTE, reaching 52.6 % in unprovoked VTE and 22.5 % in provoked VTE. Patients with VTE provoked by a medical reversible risk factor are more likely to develop recurrences than patients with recent trauma or surgery (cumulative ten-year incidence of recurrences 31.8 % vs 11.4 % respectively) [3]. Moreover, a catch-up phenomenon regarding the late recurrences in the course of VTE has been demonstrated, as diff erent duration of anticoagulant therapy fail to decrease their incidence, once the anticoagulant drug has been withdrawn [4,5].Among the other late complications, PTS develops in up to 50 % of patients previously aff ected by DVT and sometimes leads to a devastating and chronic disease, characterised by leg swelling and venous ulcers.CTEPH is a rarer, but potentially fatal complication of VTE and develops in a variable rate of subjects, ranging

Summary. Isolated distal deep vein thromboses (IDDVT) represent up to 50 % of legs deep vein thromboses (DVT). However, since their natural history is to date unknown, the need to diagnose and treat them is a matter of debate. The diagnostic strategy based on the assessment of pre-test probability and D-dimer demonstrated a scarse efficiency for IDDVT. The choice between a proximal and a complete ultrasonographic approach should be guided by the clinical context, the local expertise and the patient characteristics. Randomized and observational studies have analyzed the need of therapy and compared different regimens of anticoagulation, with conflicting results. Systematic reviews and meta-analyses tend to support the usefulness of an anticoagulant treatment, even if the optimal dose and duration are not still defined. A careful stratification of the patient’s profile, taking into account risk factors for proximal extension, recurrence and bleeding should address the therapeutic approach, which must always be discussed with an adequately informed patient. Further studies aimed to clarify the natural history of IDDVT, and to assess safety and efficacy of lower intensity and shorter duration protocols are urgently needed.