Girardi Laura, Di Nisio Marcello, Candeloro Matteo, Valeriani Emanuele, Ageno Walter
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Department of Medicine and Ageing Sciences, "G. D'Annunzio" University, Chieti-Pescara, Italy.
Eur J Clin Invest. 2025 Jan;55(1):e14311. doi: 10.1111/eci.14311. Epub 2024 Sep 12.
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.
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.
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.
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.
The management of CRT is still challenging with constant need for updated evidence to support tailored approaches.
导管相关血栓形成（CRT）是影响留置静脉导管患者的主要并发症之一，通常累及上肢深静脉系统。这种情况可导致肺栓塞和败血症等潜在危及生命的并发症。发生CRT的风险因导管类型和患者特征而异。尽管材料和技术有所进步，但CRT的实际发生率仍然相当高。关于CRT管理的现有证据仍存在争议，临床指南的建议基于非导管相关的上肢或下肢深静脉血栓形成的数据。
本叙述性综述旨在描述CRT的流行病学，回顾其管理的现有证据，并强调当前未满足的需求。
在文献复习中未应用正式的检索策略。使用的主要信息来源是Medline和国际协会的指南。
CRT的管理需要在血栓进展、复发事件和全身栓塞的风险与通常脆弱患者出血风险增加之间仔细权衡。未解决的问题包括导管的最佳管理以及抗凝治疗的类型和持续时间。直接口服抗凝剂的处方越来越多，在某些情况下是标准治疗低分子量肝素的重要替代方案。在这种情况下，开发新的抗凝药物如因子XI和XII抑制剂可能会带来更多优势。
CRT的管理仍然具有挑战性，不断需要更新的证据来支持量身定制的方法。
