Venial Sieve
October 14, 2008 4:45 PM Subscribe
Asking for a friend: Tell me about your experiences with vena cava filters.
YNMD, YNMFriend'sD.
My friend is 30 years old, significantly overweight and female. She had a PE last year which landed her in the hospital for a solid week and she has been off birth control and on Coumadin since then. About 10 days ago she was back in the hospital with super thin blood, a good lot of bleeding in her knee and severe anemia.
Now that she is out of the hospital and cleaning up the residual messes of how did this happen and why, one of her doctors suggested that at her age, a lifetime of Coumadin would cause significant issues and that she should consider looking into a vena cava filter. She is asking for any information people might have relating to this device.
She is not asking for medical advice. She will consult the proper hematologists/surgeons etc. when the time comes. She would just like experiences or information, please.
YNMD, YNMFriend'sD.
My friend is 30 years old, significantly overweight and female. She had a PE last year which landed her in the hospital for a solid week and she has been off birth control and on Coumadin since then. About 10 days ago she was back in the hospital with super thin blood, a good lot of bleeding in her knee and severe anemia.
Now that she is out of the hospital and cleaning up the residual messes of how did this happen and why, one of her doctors suggested that at her age, a lifetime of Coumadin would cause significant issues and that she should consider looking into a vena cava filter. She is asking for any information people might have relating to this device.
She is not asking for medical advice. She will consult the proper hematologists/surgeons etc. when the time comes. She would just like experiences or information, please.
Best answer: All I can say is that I'd strongly urge her to get a second opinion on the issue of IVC filters as well as the overall management of her anticoagulation. I'm not her doctor and don't know squat about the details of her condition but in general terms these are my thoughts:
Filters are really a last resort especially when thinking in terms of long-term use, and the only widely accepted indication is when anticoagulation alone has clearly failed or when an absolute contraindication to anticoagulation is present such as a risk of life-threatening bleeding. The evidence in the medical literature supporting permanent filters outside of those scenarios is limited if not non-existent. There is however fair evidence that patients with filters are actually more likely to develop clots in their legs and a sizable fraction may also develop progressive obstruction of the vena cava itself as one can imagine the seive getting clogged up over time. I've seen this on numerous occasions and it's a major, major problem you also don't want to have especially in your 30s. Consequently the filter ought not be thought of as a convenient alternative to coumadin. There are other pharmacological alternatives to coumadin if one simply can't maintain a stable INR no matter how careful about vitamin K intake.
Also worth keeping in mind is the fact that based on the most recent management guidelines for this, after a single thromboembolic many patients don't require life-long anticoagulation anyway, particularly if there was a precipitating risk factor that has since been removed.
posted by drpynchon at 6:47 PM on October 14, 2008
Filters are really a last resort especially when thinking in terms of long-term use, and the only widely accepted indication is when anticoagulation alone has clearly failed or when an absolute contraindication to anticoagulation is present such as a risk of life-threatening bleeding. The evidence in the medical literature supporting permanent filters outside of those scenarios is limited if not non-existent. There is however fair evidence that patients with filters are actually more likely to develop clots in their legs and a sizable fraction may also develop progressive obstruction of the vena cava itself as one can imagine the seive getting clogged up over time. I've seen this on numerous occasions and it's a major, major problem you also don't want to have especially in your 30s. Consequently the filter ought not be thought of as a convenient alternative to coumadin. There are other pharmacological alternatives to coumadin if one simply can't maintain a stable INR no matter how careful about vitamin K intake.
Also worth keeping in mind is the fact that based on the most recent management guidelines for this, after a single thromboembolic many patients don't require life-long anticoagulation anyway, particularly if there was a precipitating risk factor that has since been removed.
posted by drpynchon at 6:47 PM on October 14, 2008
Response by poster: drpynchon, thanks. I should have added that she is Protein C deficient. They checked her again at her second hospitalization.
posted by oflinkey at 8:46 PM on October 14, 2008
posted by oflinkey at 8:46 PM on October 14, 2008
This thread is closed to new comments.
posted by Oktober at 5:06 PM on October 14, 2008