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53 54 This regimen, however, is complex to implement in clinical practice, and due to the numerous limitations, patients�� quality of life is negatively affected.55 56 NOACs including direct thrombin ([http://www.selleckchem.com/products/MDV3100.html MDV3100 in vivo] factor IIa) inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) have emerged as promising alternatives with the potential to overcome the limitations of traditional treatments.57�C60 However, long-term experience on optimal treatment and duration of therapy is not available. Notably, outpatient or home treatment of acute PE and/or DVT represents a first step towards lowering  patients�� burden, and it may be effective and safe in appropriately selected patients with predefined and easy-to-use criteria as observed VTE recurrence, mortality and bleeding rates are low.61 62 Anticoagulant therapy is effective, but it entails expense, inconvenience, effect on quality of life and the risk of major haemorrhage, that  is, harms and benefits need to be carefully elucidated.8 63 Lifelong treatment with anticoagulation is neither uniformly applied nor recommended as it exposes patients to a potentially unnecessary long-term therapy and a substantial risk of bleeding.64 Prolonged anticoagulation carries an annual risk of major bleeding of up to 3%, and the risk of fatal bleeding is 0.25%.64 Among the many different bleeding events, intracranial haemorrhage is by far the most severe due to the increased morbidity and lethality.65 The duration of anticoagulation is primarily influenced by the underlying cause of VTE.64 66 Patients who had a VTE after surgery (provoked) have a very low annual risk of recurrence (