Treating DVT in someone with IVC filter

[Cadet133]

if someone develops unprovoked dvt while has an ivc filter in place and assuming no migration and intact filter. Whats purpose of treating dvt since it technically wont get to lungs? Would you still put in anticoagulation?

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[DrMetal]

if someone develops unprovoked dvt while has an ivc filter in place and assuming no migration and intact filter. Whats purpose of treating dvt since it technically wont get to lungs? Would you still put in anticoagulation?

Yes, you would AC them (and chances are they would need lifelong AC, you could remove the IVC, if removable). The IVC does not guarantee anything (they can sometimes be the source of a clot, it's a piece of metal in your body). Moreover, if the patient is in a hypercoag state, they could clot somewhere else in the body (north of the IVC).

 

[tantacles]

if someone develops unprovoked dvt while has an ivc filter in place and assuming no migration and intact filter. Whats purpose of treating dvt since it technically wont get to lungs? Would you still put in anticoagulation?

Clots in the legs can still cause problems. Just because they can't migrate to the lungs doesn't mean they can't cause injury!

 

[aafisahar]

ivc filters are thrombogenic after a certain amount of time. they are pretty worthless in terms of the data and outcomes. please anticoagulate patients for DVT/PE unless they absolutely cannot tolerate it (eg multiple GIB, intracranial hemorrhage).

 

[deleted480308]

with very rare exceptions yes

 

[jdh71]

if someone develops unprovoked dvt while has an ivc filter in place and assuming no migration and intact filter. Whats purpose of treating dvt since it technically wont get to lungs? Would you still put in anticoagulation?

Treat it then get it TFO

Docs that put in filters and don’t remove them, with perhaps some exceptions I can’t think of off the top of my head, aren’t being good doctors.

 

[AussieAg]

I had a patient a couple of years ago who developed descending bilateral venous thrombi from his IVC filter downward. He presented in shock because he had such little venous return that he was in a low-flow state. As others have stated, IVC filters have some utility in the short term but cause massive problems in the long term.

 

[thumbz]

I had a patient a couple of years ago who developed descending bilateral venous thrombi from his IVC filter downward. He presented in shock because he had such little venous return that he was in a low-flow state. As others have stated, IVC filters have some utility in the short term but cause massive problems in the long term.

Including migration into the aorta which I just finished talking to a vascular surgeon about.

 

[AussieAg]

Including migration into the aorta which I just finished talking to a vascular surgeon about.

That's bad, right?

 

[tantacles]

That's bad, right?

i guess

 

[JamaicanHerb]

Including migration into the aorta which I just finished talking to a vascular surgeon about.

How did an IVC filter get past the pulmonary capillaries? VSD?

 

[thumbz]

How did an IVC filter get past the pulmonary capillaries? VSD?

It actually migrates/erodes into the surrounding structures (as opposed to floating downstream and through the heart). You can see in the image below where it has made it into the small bowel (asterisk in pictures 5/6/7/8) and the aorta (black circle in image 7/8).