Pulmonary embolism management recommendations for Iliofemoral Deep Vein Thrombosis

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Iliofemoral DVT (IFDVT) mainly affects the complete or (partial thrombosis of) any part of the iliac vein or the common femoral vein, with or without involvement of other lower extremity veins or the Inferior vena cava. The clot can block blood flow and cause swelling and pain. There is a significant risk involved, when a thrombus embolize and travel to the lungs, causing pulmonary embolism.

==ACC/AHA Guidelines- Recommendations for Initial Anticoagulation for Patients With IFDVT (DO NOT EDIT) == {{cquote|

Class I
1. In the absence of suspected or proven heparin-induced thrombocytopenia, patients with IFDVT should receive therapeutic anticoagulation with either intravenous UFH (Level of Evidence: A), UFH by subcutaneous injection (Level of Evidence: B), an LMWH (Level of Evidence: A), or fondaparinux (Level of Evidence: A).

2. Patients with IFDVT who have suspected or proven heparin-induced thrombocytopenia should receive a direct thrombin inhibitor (Level of Evidence: B)''}}.

==ACC/AHA Guidelines- Recommendations for Long-Term Anticoagulation Therapy for Patients With IFDVT (DO NOT EDIT) == {{cquote|

Class I
1. Adult patients with IFDVT who receive oral warfarin as first-line long-term anticoagulation therapy should have warfarin overlapped with initial anticoagulation therapy for a minimum of 5 days and until the INR is ≥2.0 for at least 24 hours, and then targeted to an INR of 2.0 to 3.0 (Level of Evidence: A).

2. Patients with first-episode IFDVT related to a major reversible risk factor should have anticoagulation stopped after 3 months (Level of Evidence: A)

3. Patients with recurrent or unprovoked IFDVT should have at least 6 months of anticoagulation and be considered for indefinite anticoagulation with periodic reassessment of the risks and benefits of continued anticoagulation (Level of Evidence: A)

4. Cancer patients with IFDVT should receive LMWH monotherapy for at least 3 to 6 months, or as long as the cancer or its treatment (eg, chemotherapy) is ongoing (Level of Evidence: A)

Class IIb
1. In children with DVT, the use of LMWH monotherapy may be reasonable (Level of Evidence: C)}}

==ACC/AHA Guidelines- Recommendations for Use of IVC Filters in Patients With IFDVT (DO NOT EDIT) ==

{{cquote|

Class I
1. Adult patients with any acute proximal DVT (or acute PE) with contraindications to anticoagulation or active bleeding complication should receive an IVC filter (Level of Evidence: B).

2. Anticoagulation should be resumed in patients with an IVC filter once contraindications to anticoagulation or active bleeding complications have resolved (Level of Evidence: B).

3. Patients who receive retrievable IVC filters should be evaluated periodically for filter retrieval within the specific filter's retrieval window (Level of Evidence: C).

Class IIa
4. For patients with recurrent PE despite therapeutic anticoagulation, it is reasonable to place an IVC filter (Level of Evidence: C).

5. For IFDVT patients who are likely to require permanent IVC filtration (eg, long-term contraindication to anticoagulation), it is reasonable to select a permanent nonretrievable IVC filter device (Level of Evidence: C).

6. For IFDVT patients with a time-limited indication for an IVC filter (eg, a short-term contraindication to anticoagulant therapy), placement of a retrievable IVC filter is reasonable (Level of Evidence: C).

Class IIb
7. For patients with recurrent DVT (without PE) despite therapeutic anticoagulation, it is reasonable to place an IVC filter (Level of Evidence: C).

Class III
8. An IVC filter should not be used routinely in the treatment of IFDVT (Level of Evidence: B)}}.

Guidelines Resources

 * Guidelines on the management of Pulmonary embolism: Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension