An American-Canadian group of experts have, in the November 1998 issue of CHEST, published for the fifth time their recommendations for antithrombotic therapy. This remarkable consensus document was the result of an extensive review of the literature by an interdisciplinary group. Considering the impact of this document on medical practice, also outside North America, a group of European experts reviewed in detail the fifth report, particularly the sections on clinical indications of antithrombotic treatment. The aim was not to indicate the many areas of agreement and to quote literature that has become available since publication of the last consensus documents, but rather to refer to the gray zones of uncertainty and limited number of divergent opinions.