[Assessment of bleeding risk in patients with venous thromboembolism: we are still a long way from home].

Recent American, European and Dutch guidelines recommend lifelong anticoagulation after a diagnosis of unprovoked venous thromboembolism (VTE) in the absence of high bleeding risk. Major bleeding events may, however, be devastating, and are reported to have a higher case fatality rate than recurrent venous thromboembolism itself. Unfortunately, there are no validated risk assessment tools for major bleeding that help physicians determine the optimal duration of anticoagulant therapy after VTE. Furthermore, the scarce studies on this subject have focused on vitamin K antagonist treatment regimens only, covering mainly the initial weeks and first month, during which period the level of anticoagulation is unstable. New studies focusing on bleeding risk during the 'chronic' treatment period with modern anticoagulants, i.e. the direct oral anticoagulants or 'DOACs', are urgently needed. Until these are available, the 2016 Dutch guideline on anticoagulation therapy provides a table with a summary of known individual risk factors that can be applied in clinical practice.