Thrombo-occlusion of inferior vena cava filter in a patient with polycythemia vera

Abstract

This is a case of a thrombo-occlusion occurring below an inferior vena cava (IVC) filter inserted in a patient with polycythemia vera and deep vein thrombosis. The patient was a 48-year-old man with polycythemia vera and a chief complaint of swelling, redness, and bursting pain in his right leg. After admission, contrast-enhanced computed tomography scanning demonstrated a pulmonary artery thrombus and deep vein thrombosis. We inserted a Gunther tulip vena cava filter on day 1 for the prevention of pulmonary embolism (PE), and started anticoagulation therapy based on the guideline of the Japanese Circulation Society for DVT. In addition to intravenous anticoagulants, we started therapeutic phlebotomy to improve the hypercoagulability state. On day 4, our patient complained of back pain caused by thrombo-occlusion below the IVC filter, despite the anticoagulation therapy and two therapeutic phlebotomies. From this case, we concluded it is important to lower hemoglobin level and hematocrit as early as possible for IVC-filter-insertion in patients with polycythemia vera.

Clinical outcomes and causes of death in Japanese patients with long-term inferior vena cava filter implants and deep vein thrombosis

“…In those cases, we should keep anticoagulant therapy, if possible, for preventing new PE or DVT deterioration. Numerous complications are associated with the long-term use of IVC filters (over 30 days), including migration, thrombosis, and IVC perforation [13][14][15][16][17][18][19][20][21]. However, in our small number of cases, we did not experience major filter-related troubles during long-term indwelling.…”

“…IVC filters have been used for PE prophylaxis in patients with head injury, trauma, and pregnancy, and in preoperative DVT patients [9][10][11][12]. However, numerous complications are associated with the use of IVC filters, including migration, thrombosis, and IVC perforation, in patients with long-term use (over 30 days) [13][14][15][16][17][18][19][20][21]. Filter retrieval is recommended once the risk of PE is reduced and anticoagulant therapy is no longer contraindicated [22].…”

The Development of Marked Collateral Circulation due to Inferior Vena Cava Filter Occlusion in a Patient with Chronic Thromboembolic Pulmonary Hypertension Complicated with Anti-phospholipid Syndrome

“…In addition, the biconical IVCF design also induces IVCF thrombosis because of the inverted conical design and the resultant flow dynamics (19). Reports have indicated that occlusion and/or the development of thrombi in the IVCF occurred in patients with polycythemia vera, heparin-induced thrombocytopenia, and patients without anticoagulants (20-22). Furthermore, there have been reports that occlusion and/or the development of a thrombus in the IVC occurred in a patient with hereditary protein C deficiency and APS, even without an indwelling IVCF (23-25).…”