Central line-associated thrombosis and infections in patients with acute leukemias: The chicken or the egg dilemma.

Central venous catheters (CVCs) are frequently used in the management of acute leukemia, providing safe and convenient access for the safe delivery of chemotherapy, transfusions, and supportive care. However, these devices are associated with a high risk of complications, including CVC-related thrombosis (CRT) and CVC-related infection (CRI). These complications can occur concomitantly, highlighting the challenging dilemma of which comes first and which leads to the other. This review explores the complex, intricately intertwined pathophysiological mechanisms underlying this relationship in patients with acute leukemia. Catheter bacterial colonization, frequently reinforced by biofilm formation, and bloodstream infections provoke immunothrombosis, playing a part in local infection management. Platelets and the coagulation process may amplify the inflammatory responses via their interactions with the endothelium, immune cells, and the complement system. Conversely, thrombosis creates a nidus for bacterial adhesion, thereby perpetuating infection. In patients with acute leukemia, Virchow's triad- vessel wall injury, stasis, and hypercoagulability -is exacerbated by chemotherapy-induced toxicity, malignancy-related hypercoagulability, and immunosuppression. Management requires balancing infection control and thrombosis prevention. Future studies should focus on exploring the mechanistic bidirectional links between CRT and CRI as well as developing targeted preventive strategies to improve outcomes.