Image by Andre E.X. Brown
A new guideline aims to help physicians identify and manage blood clots, specifically iliofemoral deep vein thrombosis (DVT), in the groin and thigh.
The guideline states that anticoagulant therapy remains the cornerstone of management, but certain patients with iliofemoral DVT may benefit from alternative strategies, such as inferior vena cava filters, compression therapy, and clot removal or reduction strategies.
The guideline, which is based on the latest evidence, was published in CMAJ.
It was developed by a team of hematologists, interventional radiologists, vascular surgeons, emergency department physicians, and primary care physicians.
“We think this clinical practice guideline fills an important gap in knowledge for care providers by providing a practical approach to a common problem that can have serious implications for patients,” said author David Liu, MD, of Vancouver General Hospital in British Columbia, Canada.
“Complications associated with DVT can occur years after the presentation of DVT if it is not managed at onset. DVT is a life-threatening condition in the short term, with long-term implications to the patient and society if not managed properly.”
The guideline team has created a summary of recommendations and a decision tool to help physicians. Highlights include:
- All hospital staff must have the tools to diagnose and determine the severity of iliofemoral DVT.
- Anticoagulants are recommended for all patients with iliofemoral DVT, but the type and length of treatment will vary according to presentation.
- For patients not able to take anticoagulants, use of inferior vena cava filters is recommended with regular follow-up. The filters should be removed as soon as possible.
- Immediate intervention with clot removal is recommended in patients with phlegmasia cerulea dolens to reduce the associated risks of amputation and death.
- Clot removal intervention can also be considered for patients who are at low risk of bleeding to minimize possible long-term complications from iliofemoral DVT that may decrease quality of life (such as post-thrombotic syndrome).
- To manage post-thrombotic syndrome, the use of compression stockings is recommended, although the evidence that this intervention is effective is weak.
- Patient follow-up by the primary care physician is important.
