## DVT Management and Complications **Key Point:** IVC filters are NOT indicated in all DVT patients; they are reserved for specific contraindications to anticoagulation or recurrent PE despite adequate anticoagulation. ### Correct Statements | Statement | Rationale | |-----------|----------| | **LMWH first-line** | Immediate anticoagulation (LMWH or UFH) is standard; transition to warfarin or DOAC for long-term management | | **PE risk in untreated proximal DVT** | Up to 50% of untreated proximal DVT leads to PE; PE is the most common preventable hospital death | | **Post-thrombotic syndrome** | Occurs in 20–50% of DVT survivors; characterized by chronic pain, swelling, skin changes, and ulceration | ### Why Universal IVC Filter Placement Is Wrong **High-Yield:** IVC filter indications are LIMITED: 1. **Contraindication to anticoagulation** (active bleeding, thrombocytopenia, HIT) 2. **Recurrent PE despite therapeutic anticoagulation** 3. **Massive PE with haemodynamic instability** (temporary filter) 4. **Extensive iliofemoral thrombosis with poor cardiopulmonary reserve** **Warning:** Universal IVC filter placement increases the risk of: - Filter thrombosis - IVC thrombosis - Recurrent DVT (paradoxically) - Long-term complications (post-filter syndrome) **Clinical Pearl:** Current guidelines (ACCP, ASCO) recommend anticoagulation as the primary strategy for all DVT patients unless a specific contraindication exists. IVC filters are adjunctive, not routine. [cite:Harrison 21e Ch 297]
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