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The article presents a clinical analysis of the patient with a newly developed unprovoked episode of venous thromboembolic events. It discusses the challenges in the diagnosis of pulmonary embolism, the need for thrombolytic therapy in patients with pulmonary arterial thromboembolism of medium risk. The guidelines for diagnosis of antiphospholipid syndrome in accordance with modern principles are provided. It also considers the issues of anticoagulant treatment.

The article presents a clinical discussion of the patient with recurrent venous thromboembolic complications. It also provides recommendations on modern principles of diagnostics, choice of medical tactics in patients with this pathology. Much attention is paid to the issues of anticoagulant treatment, which inadequacy or failure results in the development of severe, difficultly treatable complications.

The review tells about challenges of antithrombotic therapy in patients after acute coronary syndrome. The efficacy and safety of long-term administration of anticoagulants (warfarin as well as novel anticoagulants), in addition to standard antiplatelet therapy, is discussed. The focus is on rivaroxaban, low doses of which are officially indicated for the prevention of cardiovascular death and myocardial infarction in patients after acute coronary syndrome occurring with increased values of myocardial injury markers. Clinical characteristics of patients feasible for this treatment approach are considered.