Last updated March 15, 2022

Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Recommendations

Acute PE

In patients with acute PE with a contraindication to anticoagulation therapy, we suggest an IVC filter be considered based on various clinical risk factors, as outlined in the rationale. (, )
Strength of recommendation: Limited ★★☆☆
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Acute DVT

In patients with acute DVT without PE and with a contraindication to anticoagulation therapy, we suggest that an IVC filter be considered based on various clinical risk factors, as outlined in the rationale. (, )
Strength of recommendation: Consensus ★☆☆☆
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Anticoagulation for VTE

  • In patients undergoing anticoagulation for acute VTE (DVT, PE) in whom a contraindication to anticoagulation develops, we suggest that an IVC filter be considered in the setting of ongoing significant clinical risk for PE.
Strength of recommendation: Consensus ★☆☆☆
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  • In patients undergoing extended anticoagulation for VTE (DVT, PE) and have completed the acute phase of treatment in whom a contraindication to anticoagulation develops, we suggest that an IVC filter not be placed, with rare exceptions.
Strength of recommendation: Consensus ★☆☆☆
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Recurrent VTE

In patients who are receiving therapeutic anticoagulation for VTE (DVT, PE) who experience a recurrent VTE, we suggest that a filter not be placed, with few exceptions. Reasons for anticoagulation failure should always be addressed. (, )
Strength of recommendation: Consensus ★☆☆☆
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Routine IVC Filter Placement

In patients with acute VTE (DVT, PE) who are being treated with therapeutic anticoagulation, we recommend against routine placement of an IVC filter. (, )
Strength of recommendation: Moderate ★★★☆
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PE with Advanced Therapies

In patients with acute PE who are undergoing advanced therapies, we suggest considering the placement of IVC filters only in select patients, as outlined in the rationale.
Strength of recommendation: Limited ★★☆☆
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DVT with Advanced Therapies

In patients with DVT who are undergoing advanced therapies, we suggest considering the placement of IVC filters only in select patients, as outlined in the rationale.
Strength of recommendation: Limited ★★☆☆
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Trauma Patients without Known VTE

In trauma patients without known acute VTE, we recommend against the routine placement of IVC filters for primary VTE prophylaxis.
Strength of recommendation: Moderate ★★★☆
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Major Surgery Patients without Known VTE

In patients without known acute VTE who are undergoing major surgery, we suggest against routine placement of IVC filters.
Strength of recommendation: Consensus ★☆☆☆
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Indwelling IVC Filters with No Anticoagulation Indication

In patients who have indwelling IVC filters with no other indication for anticoagulation, we cannot recommend for or against anticoagulation.
Strength of recommendation: Consensus ★☆☆☆
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Indwelling IVC Filters with Mitigated PE Risk

  • In patients with indwelling retrievable/convertible IVC filters whose risk of PE has been mitigated or who are no longer at risk for PE, we suggest filters be routinely removed/converted unless risk outweighs benefit.
Strength of recommendation: Consensus ★☆☆☆
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  • In patients with indwelling permanent IVC filters whose risk of PE has been mitigated or who are no longer at risk for PE, we suggest against routine removal of filters.
Strength of recommendation: Consensus ★☆☆☆
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Complications and Indwelling IVC Filters

In patients with complications attributed to indwelling IVC filters, we suggest filter removal be considered after weighing filter- versus procedure-related risks and the likelihood that filter removal will alleviate the complications.
Strength of recommendation: Consensus ★☆☆☆
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Structured Follow-up

In patients who have an IVC filter, we recommend the use of a structured follow-up program to increase retrieval rates and detect complications.
Strength of recommendation: Limited ★★☆☆
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Planned Filter Removal

In patients in whom IVC filter removal is planned, we suggest against routine preprocedural imaging of the filter and the use of laboratory studies except in select situations, as outlined in the rationale.
Strength of recommendation: Consensus ★☆☆☆
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Filter Removal without Standard Snare Techniques

In patients undergoing filter retrieval whose filter could not be removed by using standard techniques, we suggest attempted removal with advanced techniques, if appropriate and if the expertise is available, after reevaluation of risks and benefits.
Strength of recommendation: Consensus ★☆☆☆
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Filter Placement Technique

In patients undergoing IVC filter placement, we cannot recommend for or against any specific placement technique. (, )
Strength of recommendation: Consensus ★☆☆☆
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Recommendation Grading

Overview

Title

Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Authoring Organization

Publication Month/Year

October 2, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D020246 - Venous Thrombosis, D011655 - Pulmonary Embolism, D056824 - Upper Extremity Deep Vein Thrombosis, D016769 - Embolism and Thrombosis, D004617 - Embolism

Keywords

VTE, Venous Thromboembolism, deep vein thrombosis, pulmonary embolism, DVT, PE

Source Citation

Thomas L. Ortel, Ignacio Neumann, Walter Ageno, Rebecca Beyth, Nathan P. Clark, Adam Cuker, Barbara A. Hutten, Michael R. Jaff, Veena Manja, Sam Schulman, Caitlin Thurston, Suresh Vedantham, Peter Verhamme, Daniel M. Witt, Ivan D. Florez, Ariel Izcovich, Robby Nieuwlaat, Stephanie Ross, Holger J. Schünemann, Wojtek Wiercioch, Yuan Zhang, Yuqing Zhang; American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19): 4693–4738. doi: https://doi.org/10.1182/bloodadvances.2020001830

Methodology

Number of Source Documents
360
Literature Search Start Date
January 1, 2014
Literature Search End Date
January 1, 2019