BACKGROUND: Venous thromboembolism (VTE) is a major health problem worldwide. There are scarce data on the recent temporal trends of patients with VTE after the widespread use of direct oral anticoagulants (DOACs). METHODS AND RESULTS: In a Japanese nationwide hospital administrative database, we identified 20,217 patients with VTE from 2017 to 2023, and evaluated their temporal trends in management strategies and clinical outcomes. The proportions of outpatient treatment among patients with out-of-hospital isolated deep vein thrombosis increased significantly (p trend <
0.001, Pearson's R = 0.046) over time from 2017 to 2023. The proportions of warfarin use decreased significantly over time from 2017 to 2023 (p trend <
0.001, Pearson's R = -0.053), whereas the use of most DOACs increased. The proportions of thrombolysis (p trend <
0.001, Pearson's R = -0.046) and inferior vena cave filter (p trend <
0.001, Pearson's R = -0.048) use decreased significantly over time from 2017 to 2023. The incidence of 6-month all-cause death, VTE recurrence, and bleeding was 9.1 %, 2.1 %, and 4.4 %, respectively. The incidence decreased in 6-month all-cause death (p trend = 0.018, Pearson's R = -0.017) and bleeding (p trend <
0.001, Pearson's R = -0.029) over time from 2017 to 2023. CONCLUSIONS: The current Japanese nationwide hospital administrative database provided the recent temporal trends in the real-world management strategies and clinical outcomes of VTE, which revealed several temporal changes in these aspects after the widespread use of DOACs.