Here is a synthesis of evidence and expert opinion.
Key points and observations:
Evidence is gradually driving a shift in thinking towards longer duration of treatment.
Though the precise duration of treatment for various situations may be uncertain, management and follow up are long term.
Although the risk of recurrence after spontaneous VTE is greater, the distinction between spontaneous and provoked VTE should not be absolute in making treatment decisions.
“Hypercoagulability work ups” are controversial and should be considered on an individual basis.
There is an emerging conflict between population based and individualized approaches. The former, which represents the current consensus (provoked=limited treatment, spontaneous=long term) works well in clinically obvious situations but is simplistic. The latter approach may be better in gray areas. The authors suggest a hybrid approach and provide an algorithm.