**4. Discussion/conclusion**

A hypercoagulable state increases the patient's risk of developing arterial or venous thrombosis with subsequent complications. Venous thromboembolism is much more common, places a greater financial burden on health systems and therefore more data are available for its management.

Venous thromboembolism is now considered a multifaceted condition, usually resulting from the interaction of inherited and acquired risk factors, with different penetration in the general population and also with distinct risk profiles.

In terms of treatment, primary anticoagulant prophylaxis is recommended only for selected cases, while most patients require no treatment other than minimization of modifiable risk factors.

For the treatment of a first thrombotic event, secondary prophylaxis or relapse, anticoagulation is recommended. Although most episodes of a first thrombosis episode, especially when transient risk factors are identified, require short-term anticoagulation (3–6 months), there are cases where long-term (>6 months) or even indefinite anticoagulation may be given.

When choosing appropriate therapy, a large number of factors must be weighed, such as patient education, preference, and compliance for certain drugs, their availability for long-term follow-up, the financial burden of some therapies, or quality of life, for example when choosing between parenteral and oral treatment.

For patients with venous thromboembolism, the modern approved and guidelinesupported treatment is DOAC, with superior efficacy and safety, and quality of life profiles compared to traditional vitamin K antagonist therapy. However, a limitation of DOAC is for the treatment of patients with high-risk antiphospholipid syndrome, where, in a recent study, DOAC showed no efficacy benefit but a higher risk compared to warfarin treatment.

Even though DOAC is finding an increasing number of indications, further research is needed to fully understand what is the best drug choice for each patient, for each condition, for the dose needed, for the duration of treatment, and for follow-up.

In conclusion, hypercoagulable conditions develop as a result of numerous individual or coexisting genetic or acquired risk factors that may be present and induce a higher risk for the patient to develop thrombotic complications. To prevent them, asymptomatic patients may have to undergo anticoagulant treatment in selected cases. For initial treatment and prevention of relapses, the modern and most recommended treatment is with direct anticoagulants, except for patients with high-risk antiphospholipid syndrome.

*Anticoagulation - Current Perspectives*
