Patients with acute leukemia (AL), including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), exhibit a dual hemostatic imbalance characterized by both bleeding and thrombotic tendencies. Limb thrombosis, encompassing venous (deep vein thrombosis, DVT) and arterial events, represents a challenging complication due to concurrent thrombocytopenia, coagulopathy, central venous catheter (CVC) use, and intensive chemotherapy. This prospective observational study analyzed 62 consecutive adult patients with AL who developed limb thrombosis at a tertiary hematology-oncology center in Tashkent, Uzbekistan, between January 2025 and December 2025. Diagnosis integrated clinical evaluation, D-dimer testing, duplex ultrasound for venous thrombosis, and CT angiography for arterial involvement or suspected pulmonary embolism (PE). Complications arose in 64.5% of cases, including PE in 25.8%, recurrent thrombosis in 19.4%, acute limb ischemia (ALI) in 12.9%, and post-thrombotic syndrome (PTS) in 14.5%. Low-molecular-weight heparin (LMWH) served as the primary anticoagulant in 83.9% of patients, frequently supported by platelet transfusions to maintain counts ≥30–50 × 10⁹/L during therapy. Treatment achieved thrombus resolution or stabilization in 72.6% of cases; however, major bleeding (ISTH criteria) occurred in 16.1%, and limb amputation was required in 6.5% of ALI cases. These results demonstrate that individualized, multidisciplinary management balancing thrombotic and hemorrhagic risks can yield acceptable outcomes. Early diagnostic imaging and platelet-supported LMWH therapy are central to minimizing morbidity in this high-risk group.

Acute leukemia, limb thrombosis, venous thromboembolism, acute limb ischemia, anticoagulation, thrombocytopenia, low-molecular-weight heparin, pulmonary embolism

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