Unveiling the complexities of catheter-related thrombosis: risk factors, preventive strategies, and management.

Abstract

Catheter-related deep venous thrombosis (CR-DVT) is a common complication of central venous catheters, however optimal prophylactic and treatment strategies have yet to be fully defined. While the use of anticoagulation for CR-DVT prophylaxis is not routinely recommended, current available data offer heterogeneous results due to small sample size, non-uniform study design, and varying comorbid conditions. Available guidelines for the treatment of CR-DVT generally recommend a limited duration of anticoagulation after catheter removal. If ongoing use is required and the device remains functional, guidelines support anticoagulation throughout the time the catheter remains in place. It is worth acknowledging that data guiding these recommendations is largely derived from observational studies of upper extremity CR-DVT, along with randomized trials of anticoagulation in patients with lower extremity DVT. Therefore, large, randomized controlled trials are desperately needed to define optimal management, especially in patients who are at high risk for bleeding. This review explores the epidemiology and risk factors of CR-DVT, diagnostic, prophylactic and treatment strategies, guideline recommendations, and future advances in the field, including the introduction of novel anticoagulants. With current available evidence, we also conclude with an individualized approach to preventing and managing CR-DVT to assist clinicians who are faced with this common clinical scenario.