Management of inferior vena cava thrombosis: guidance from the Italian Society for the Study of Haemostasis and Thrombosis (SISET)

Inferior vena cava thrombosis (IVCT) is an uncommon manifestation of venous thromboembolism, characterized by heterogeneous clinical presentation and limited disease-specific evidence. Owing to its rarity, diagnostic and therapeutic strategies are largely extrapolated from studies in proximal lower-limb deep vein thrombosis, resulting in substantial variability in clinical practice. This guidance document, developed by the Italian Society for the Study of Haemostasis and Thrombosis (SISET), aims to provide pragmatic, evidence-informed recommendations for the identification, diagnosis, thrombophilia work-up, and management of IVCT. The guidance is based on a structured review of the available literature and expert consensus. The document addresses key clinical questions, including which patients should be investigated for IVCT, the most appropriate diagnostic imaging strategies, indications for thrombophilia testing, and optimal pharmacological and interventional management. Particular attention is given to clinical scenarios that should prompt dedicated evaluation of the inferior vena cava, such as bilateral lower-extremity deep vein thrombosis, atypical abdominal or lumbar pain, and extensive venous obstruction. Anticoagulation is recommended as the cornerstone of IVCT treatment, while endovascular or surgical interventions should be reserved for selected patients with acute extensive thrombosis or chronic symptomatic ilio-caval obstruction. Given the paucity of high-quality, IVCT-specific evidence, these recommendations emphasize individualized decision-making and highlight the need for prospective studies in this field.