Extended oral anticoagulation after incident venous thromboembolism – a paradigm shift?

Introduction Patients with incident venous thromboembolism carry a chronic risk of suffering a recurrent event. Anticoagulation is effective at preventing recurrence during treatment but also associated with risk of bleeding. Hence, the dilemma of optimal anticoagulant treatment duration beyond the acute treatment phase remains a clinical challenge in the management of venous thromboembolism.Areas covered This review summarizes the current evidence for extended oral anticoagulant treatment after incident venous thromboembolism, and discusses dilemmas involved in treatment decisions related to extended secondary prevention.Expert opinion Results from landmark venous thromboembolism-extended treatment studies focused on direct oral anticoagulants suggest a paradigm shift of the risk–benefit balance in favor of extended anticoagulant treatment. Nevertheless, patient preferences need to be considered while persistent concerns about enduring risk of bleeding must be addressed for the new paradigm to be implemented into clinical practice.