Catheter-related deep vein thrombosis: Where are we at and where are we going? Updates and ongoing unmet clinical needs

Background: Catheter-related thrombosis (CRT) is one of the major complications affecting patients with indwelling venous catheters, usually involving the upper extremity deep venous system. This condition can lead to potentially life-threatening complications such as pulmonary embolism and sepsis. The risk of developing CRT varies depending on type of catheters and patient characteristics. Despite advances in materials and technologies, the actual incidence of CRT is still considerable. Available evidence on CRT management remains controversial, and clinical guidelines base their recommendations on data from non-catheter related upper extremity or lower extremity deep venous thromboses. Aims: This narrative review aims to describe the epidemiology of CRT, to review the available evidence on its management and to highlight the current unmet needs. Methods: No formal search strategy was applied for the revision of the literature. The main sources of information used were Medline and guidelines from international societies. Content: The management of CRT requires a careful balance between the risk of thrombus progression, recurrent events, and systemic embolization and the increased bleeding risk in often fragile patients. Open issues include the optimal management of the catheter and the type and duration of anticoagulant therapy. Direct oral anticoagulants are increasingly prescribed, representing an important alternative to the standard of care low molecular weight heparins in selected cases. The development of new anticoagulant drugs such as factors XI and XII inhibitors may offer further advantages in this context. Conclusions: The management of CRT is still challenging with constant need for updated evidence to support tailored approaches.