Therapeutic Management of Septic Venous Thrombosis: A Narrative Review

Septic venous thrombosis is an uncommon complication but clinically significant due to its high morbidity and mortality and the complexity of therapeutic decision-making. The lack of standardized guidelines and the scarcity of high-quality studies complicate clinical management, as most available evidence derives from highly heterogeneous case series and retrospective studies. In this context, a comprehensive overview is essential to guide real-world practice.

This manuscritp provides an in-depth review of the treatment of septic venous thrombosis at its most frequent sites, including the portal vein and its branches, the pelvic veins, catheter-associated events, the internal jugular vein, and dural venous sinus thrombosis.

Across all scenarios, early initiation of appropriate antibiotic therapy is the cornerstone of treatment and must be tailored to the suspected source of infection and the patient's clinical course. In parallel, although the role of anticoagulation remains debated, several observational studies suggest potential benefits in terms of recanalization and complication prevention, particularly in selected patients.

However, the decision to anticoagulate should be carefully individualized within a multidisciplinary framework. Despite the recent progress, many clinical uncertainties remain. Therefore, well-designed clinical trials are needed to define optimal therapeutic strategies for this condition.