If anticoagulant therapy is stopped, the risk of recurrence after unprovoked venous thromboembolism is high. After anticoagulant treatment for at least three months, the indication for prolonging therapy should be decided after thorough evaluation of individual risk factors for recurrence and bleeding. Clinical parameters, imaging modalities and D-dimer levels can guide this decision. The lower risk of bleeding on non-vitamin K-antagonist oral anticoagulants compared to warfarin is expected to increase the number of patients on extended treatment, but costs and patients' preferences should be considered.