New Horizons in Venous Thromboembolism Management: A Narrative Review

Venous thromboembolism (VTE) remains a major cause of cardiovascular morbidity and mortality worldwide, and is a staple of daily clinical practice. While we have seen significant advancements in therapeutics over the last 20 years, several questions and controversies remain in the selection and duration of available therapies, as well as balancing the consequences of VTE and the bleeding risk imposed by treatment modalities. In recent years, new evidence based on randomized trials and registries have reshaped the therapeutic landscape. This narrative review synthesizes the latest advancements and future directions in VTE care, including recent guideline updates, new evidence pertaining to established pharmacologic therapy, risk stratification, interventional and procedural options, and special populations including the management of cancer-associated thrombosis, and the emerging promise of factor XI inhibition. In diagnostics, the field is moving beyond traditional methods with the investigation of novel biomarkers from proteomic and metabolomic studies and the clinical implementation of advanced imaging modalities like photon-counting CT, which offers superior resolution at lower radiation doses. Artificial intelligence is emerging as a transformative tool, potentially enhancing diagnostic accuracy in imaging. Ultimately, this review will assist clinicians in integrating evolving evidence with patient-centered decision-making to maximize benefit while minimizing harm and treating the diverse and common clinical problems of VTE.