The incidence of
venous thromboembolism (VTE) and VTE‑related morbidity and mortality increase with advancing age. Over the past decade, substantial advances in the treatment of VTE have been achieved. Most notably, direct oral
anticoagulants (DOACs) were introduced, which offer simple treatment regimens across a broad spectrum of patients with VTE and have become the first‑choice
anticoagulants in many individuals in this population. Even though elderly patients are underrepresented in clinical trials, the extrapolation of overall study results to the elderly subpopulation can be considered justified regarding acute VTE treatment and the choice of
anticoagulant agent. In the elderly, DOACs are not only associated with a lower
bleeding risk but they also appear to be even more efficacious than
vitamin K antagonists in preventing recurrent VTE during the acute treatment period. Determining the optimal
treatment duration is the most challenging aspect of VTE management in elderly patients. The risk of
bleeding increases with advancing age, and several risk factors for recurrent VTE after stopping anticoagulation are also more frequent in the elderly. Clinical decision rules estimating the risk of recurrent VTE and
bleeding have limited utility in elderly patients. Shared decision making considering patients' preferences and values is therefore crucial to help determine individual
treatment duration in these patients.