预防和治疗白血病患者的血栓形成仍然是一个重大挑战，仍有许多临床问题需要解决。事实上，证据不足使静脉血栓栓塞事件的管理变得困难且不均匀。由于血小板减少症，急性髓性白血病（AML）患者在调查癌症预防和治疗血栓形成的试验中不常见，缺乏前瞻性数据。同样，对于白血病患者使用抗凝剂的治疗方法是从最初制定的固体癌症指南中推论而来的，在血小板减少的人群中缺乏明确的建议。重要的是，区分具有出血高风险和具有主要血栓风险的患者仍然非常困难，目前没有预测性评分得到验证。因此，血栓的处理经常依赖于临床医生的经验，并根据个体化患者的情况进行调整，不断平衡血栓和出血风险。未来的指南和试验应该解决谁将受益于初级预防以及如何适当治疗血栓事件等一些未解决的问题。此外，应该做出更大的努力来确定能够指导临床医生管理这种潜在严重并发症的强有力预测因素。© 2023作者（s），在Springer Science + Business Media，LLC，Springer Nature的独家许可下发表。

Prophylaxis and treatment of thrombosis in leukemic patients still represent a major challenge with several clinical questions yet to be solved. Indeed, the paucity of evidence makes the management of venous thromboembolic events difficult and not uniform. Due to thrombocytopenia, patients with acute myeloid leukemia (AML) are underrepresented in trials investigating prophylaxis and treatment of thrombosis in cancer, and prospective data are lacking. Likewise, the therapeutic approach with anti-coagulants in leukemic patients is inferred from guidelines originally developed in the solid cancer setting and clear recommendations in the thrombocytopenic population are limited. Importantly, the discrimination of patients at high risk of bleeding from those with a predominant risk of thrombosis remains extremely difficult with no predictive score validated so far. Thus, the management of thrombosis often relies on clinician experience, and it is tailored to the individual patient, constantly balancing thrombotic and hemorrhagic risks. Who would benefit from primary prophylaxis and how a thrombotic event should be appropriately treated are some of the unanswered questions that the future guidelines and trials should address. Moreover, a greater effort should be made to identify robust predictive factors able to guide clinicians in the management of this potential serious complication for AML patients.© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.