Direct oral anticoagulants have become an attractive option for many patients requiring oral anticoagulation. For patients with non-valvular atrial fibrillation current guidelines propose their preferential use based on the results of large randomized trials. However, when applying those results to non-selected patients with multiple medical conditions in “real world” settings caution is prudent because the complication rate in these patients may be higher than in the study populations. The aims of this study were a) to assess the overall prevalence of anticoagulation in patients discharged in 2013 after being hospitalized for a variety of medical conditions and b) to analyse the selection of various oral anticoagulation regimens under “real world” conditions in the context of diverse comorbidities. Methods This study was designed as retrospective analysis of patients discharged from the medical inpatient service at the University Hospital of Zurich in 2013. Patients receiving anticoagulation therapy were identified by codes of the anatomical therapeutic chemical classification system of their discharge medications using a computerized search algorithm. Medications and patient characteristics were extracted from the electronic medical record. Results Between January 1 and December 31 1439 discharge reports were generated by the general internal medicine service, of which 304 (21.1%) were on patients receiving therapeutic anticoagulation. Out of these, 228 patients received oral anticoagulants: 204 (89.5%) vitamin K antagonists and 24 (10.5%) the direct oral anticoagulant rivaroxaban. Patients on rivaroxaban tended to have fewer diagnoses and discharge medications, better renal function and shorter hospital stays, but the differences to the patients on vitamin K antagonists were not statistically significant, possibly due to the relatively low number of patients receiving rivaroxaban. Conclusions In a “real world” setting 21.1% of general internal medicine patients were discharged on anticoagulation therapy after hospitalization for a variety of conditions. The preferential use of vitamin K antagonists in 89.5% of orally anticoagulated patients likely reflects a combination of physicians’ extensive experience and familiarity with vitamin K antagonists in addition to patient characteristics and clinical indications. The role of clinical patient characteristics on anticoagulant choice remains to be clarified.