OBJECTIVES: To describe initial anticoagulant treatment after venous thromboembolism (VTE) as recorded in electronic healthcare records and relate this to the underlying risk factors, guidelines and recurrence rates. METHODS: From the PHARMO GP Database, patients with deep venous thrombosis (DVT) or pulmonary embolism (PE) in 2007-2011 were identified for whom out-patient pharmacy dispensing data was available. Cancer, other risk factors and type and duration of anticoagulant treatment (LMWH and/or VKA) within 90 days of diagnosis and recurrence of VTE were assessed. RESULTS: The study cohort included 1,581 VTE patients: 1,053 with DVT and 528 with PE. For 70-86% of the VTE patients, dispensings of anticoagulant treatment were observed within 90 days. The median duration of anticoagulant dispensings among patients for whom both LMWH and VKA dispensings were observed was 3.5 months with provoked VTE and 3.7 months with unprovoked VTE. In these cohorts the observed median dispensing duration of (initial) LMWH treatment was 12 days. Recurrent VTE occurred mostly after discontinuation of anticoagulant treatment. Longer dispensing durations were observed among patients without recurrence. CONCLUSIONS: Treatment after VTE as captured in observational healthcare data generally follows the Dutch guidelines. However, many patients received LMWH dispensing covering periods longer than the recommended 5-10 days. Furthermore, among patients with a VTE recurrence shorter duration of anticoagulant treatment was observed compared to patients without a recurrence.