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Background: Despite the existence of active prophylaxis strategies for patients at risk of venous thromboembolism (VTE), people still suffer from this disease. To establish the setting in which VTE occurs and how it can be prevented, a study was conducted aimed at analysing the circumstances surrounding VTE development., Patients and Methods: In a nationwide study, 629 patients (54% female) with acute deep vein thrombosis (DVT) or pulmonary embolism (PE) were recruited consecutively at 17 centres (78.4% with DVT, 5.1% with PE, 16.5% with both). The physicians completed a standardised questionnaire together with the patients on the day the diagnosis was made, or a few days later. The following items were included: general information, circumstances that could increases VTE risk within the previous 6 weeks, action taken to prevent VTE within the previous 6 weeks, specific VTE risk factors. Patients were defined as being 'in a medical setting' if they had had contact with a physician within the 6-week period prior to VTE diagnosis., Results: A total of 286 (45.5%) patients were classified in a medical setting, but 343 (54.5%) patients were not. Of those who were not in a medical setting within the last six weeks, 12.0% had returned from a journey and 15.5% had restricted mobility. Of those within a medical setting, only 80 (28.0%) patients had received heparin as prophylaxis. Thus, the largest group of patients with VTE today is not within a medical setting. The next largest group of patients were in a medical setting but received no heparin as prophylaxis. Those with a failed or inadequate use of prophylaxis represented the smallest group., Discussion: More than 50% of those who have acute VTE are not being reached by our present day VTE prophylaxis strategies., (© 2014 John Wiley & Sons Ltd.)