Case 70 – part 3 – summary

For our last short case this week we looked at a 50 year old gentleman who developed a subdural following an assault. He had been diagnosed with a provoked DVT 1 week prior following knee surgury and had been loaded on warfarin (although INR remained subtgereputic at 1.4) and tinzaparin. He was given protamine and vitamin k prior to surgery and his anti Xa post op was 0.1. 
In this gentleman, given the nature of his surgery, we are unable to immediately therapeutically anticoagulate him. Given the recent femoral DVT a temporary IVC filter was inserted. Following discussion with the surgical team prophylactic anticoagulation was able to be started after 72 hours and the surgical team felt that after 14 days we could start to therapeutically anticoagulate the patient with LMWH. 
The patient continued to improve and once therapeutic anticoagulation was restarted, and the teams felt no interruption was required, the IVC filter was removed.

Indications for consideration of IVC filter include recent VTE (within 1 month) when anticoagulation needs to be interrupted eg surgery and PE despite therapeutic anticoagulation in selected patients. Complications of IVC filters can include stent thrombosis and stent migration so it is important to consider removal if no longer required.

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