Lethal Pulmonary Embolism in a Patient With Primary Antiphospholipid Syndrome and a Vena Caval Filter

Lee, Hing-Chung; Laya, Mary B.

doi:10.1378/chest.105.1.312

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…At the present, there are no studies that have identified any populations at greater risk for complications associated with vena caval filter placement. However, anecdotal experiences suggest that patients with thrombophilic states, in particular, malignancies, may be at higher risk of developing thrombotic complications as a result of filter placement or experience suboptimal control of the thrombotic process [49,71,[89][90][91][92]. A situation in which this statement would be particularly accurate is Trousseau syndrome, a unique hypercoaguable state associated with solid tumors, in particular adenocarcinomas, which results in migratory thrombophlebitis in the arterial and venous circulations.…”

Section: Is There Any Identifiable Risk Profile Associated With An Increased Risk Of Complications From Vena Caval Filters?mentioning

confidence: 99%

Vena Caval Filters: A Review for Intensive Care Specialists

Streiff

2003

J Intensive Care Med

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Venous thromboembolism (VTE) is a common complication among patients in the intensive care unit. While anticoagulation remains standard therapy, vena caval filters are an important alternative when anticoagulation is contraindicated. To determine the safety and efficacy of vena caval filters in the treatment of VTE, a comprehensive review of the English-language medical literature was performed. Except for one randomized controlled trial, the literature supporting the use of vena caval filters consists almost exclusively of case series, which in many instances are limited by incomplete and short follow-up. While case series suggest that filters function effectively in the prevention of pulmonary embolism (2%-4% symptomatic pulmonary embolism [PE], fatal PE < 2%), recent higher quality studies indicate that filters may not provide significant additional protection to that provided by anticoagulation alone. Furthermore, filters are associated with a 2- fold increase in the incidence of recurrent DVT. Until randomized comparative studies are available, the safety and efficacy of all the available devices should be considered to be roughly equivalent. Since filters do not inhibit continued clot formation, all filter patients should receive anticoagulation for durations appropriate for their thrombotic disorder. Although extended anticoagulation may prevent thrombotic complications associated with filter placement, this strategy has yet to be experimentally tested. While many additional indications for vena caval filter use have been proposed (VTE in cancer patients, PE prophylaxis in trauma patients, etc), well-designed clinical trials demonstrating their efficacy in these situations are lacking. Further development of temporary/retrievable filters, which offer the potential to avoid the long-term complications of permanent filters, should be a research priority. Until additional data are available, vena caval filters should generally be restricted to patients with VTE who cannot receive anticoagulation.

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Section: Is There Any Identifiable Risk Profile Associated With An Increased Risk Of Complications From Vena Caval Filters?mentioning

confidence: 99%

Vena Caval Filters: A Review for Intensive Care Specialists

Streiff

2003

J Intensive Care Med

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“…Lee et al reported on a 61-year-old patient with primary antiphospholipid syndrome who developed massive fatal pulmonary emboli despite placement of a bird's nest filter seven months previously. At autopsy, both recent and organized thrombus was seen extending proximally from the filter (13 Experts recommend avoiding permanent filters in the acute setting, as these devices can be associated with a variety of adverse events, including IVC thrombosis and PE. Also, IVC filter placement can exacerbate thrombotic complications in patients with heparin-induced thrombocytopenia (7).…”

Section: Discussionmentioning

confidence: 99%

Safety of retrievable inferior vena cava filters in patients with the antiphospholipid syndrome

2018

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Objective: Consideration for placement of an inferior cava filter arises in patients with APS where cessation of anticoagulation is necessary or thrombotic complications continue despite maximal anticoagulation. Permanent IVC filters are recommended to be avoided. We evaluated the safety of placement and removal of retrievable inferior vena cava filters in patients with APS. Methods: Case series of 5 patients with APS and aPL antibodies who had placement and removal of retrievable IVC filter (because of contraindication to anticoagulation or ongoing thrombosis despite full anticoagulation) to assess for safety, presence of clots in the vena cava or on the filter while in the body, evidence of PE, or clot on the explanted filter. Results: Insertion and removal, even while on anticoagulation, was safe. There was no evidence of clot in the vena cava, on the filter or pulmonary embolism in all cases. Conclusion: Where necessary, retrievable IVC filters may be safer in APS patients but should not be left in for long periods of time.

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“…Longterm therapy, in which the international normalized ratio is maintained at or above 3, is advisable in these patients [3]. The therapeutic role of corticosteroids in primary APS is still controvertial [10].…”

Section: Discussionmentioning

confidence: 99%

A patient with haemoptysis, rapidly changing pulmonary infiltrates and left flank pain

Lai

Kuo²,

Wu³

1996

Eur Respir J

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A A p pa at ti ie en nt t w wi it th h h ha ae em mo op pt ty ys si is s, , r ra ap pi id dl ly y c ch ha an ng gi in ng g p pu ul lm mo on na ar ry y i in nf fi il lt tr ra at te es s a an nd d l le ef ft t f fl la an nk k p pa ai in n Case history A 28 year old male patient sought medical advice because of a 2 week history of haemoptysis. He began to suffer from vague right chest pain 1 month earlier, followed by intermittent fever, progressive dyspnoea and cough with blood clots in the sputum. Occasional left upper quadrant and left flank pain were also noted. He lost 6 kg in weight during this period. Pneumonia was suspected from the initial chest radiograph ( fig. 1a) at a local hospital, and antibiotics were prescribed for 5 days but without significant benefit. The patient was referred to this hospital for a second opinion.The past medical history was noncontributory. Physical examination revealed a well-developed man in mild respiratory distress. The body temperature was 37°C, blood pressure was 130/70 mmHg, pulse 100 beats·min -1 , and respiratory rate 30 breaths·min -1 . Breathing sounds were diminished in bilateral lower lung fields, with some crackles. Heart sounds were regular and without murmurs. There was tenderness of the left costovertebral angle and mild swelling of the right thigh. No skin rash was detected, with the exception of some ecchymosis at the right inguinal area. Neither digital clubbing nor splinter haemorrhage was found. A complete blood count revealed: white blood cells (WBC) 24.4×10 9 cells·L -1 ; haemoglobin (Hb) 110 g·L -1 ; and 86×10 9 platelets·L -1 . Determination of arterial blood gas values in room air showed: a pH of 7.48; arterial carbon dioxide tension (Pa,CO 2 ) of 4.8 kPa (36 mmHg); and arterial oxygen tension (Pa,O 2 ) of 9.4 kPa (71 mmHg). Prothrombin time and partial prothrombin time were both prolonged. Sputum was negative for acid-fast bacilli (AFB), fungi and malignant cells. Urinalysis was normal.Imaging studies, including a follow-up chest radiograph 5 days later ( fig. 1b), the sequential contrastenhanced computed tomographic (CT) scans at the level of the aorticopulmonary window ( fig. 2a), of the lower thorax ( fig. 2b), and of both kidneys ( fig. 3), are shown. CASE FOR DIAGNOSIS

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Lethal Pulmonary Embolism in a Patient With Primary Antiphospholipid Syndrome and a Vena Caval Filter

Cited by 9 publications

References 9 publications

Vena Caval Filters: A Review for Intensive Care Specialists

Vena Caval Filters: A Review for Intensive Care Specialists

Safety of retrievable inferior vena cava filters in patients with the antiphospholipid syndrome

A patient with haemoptysis, rapidly changing pulmonary infiltrates and left flank pain

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