816 Identifying patients at high risk of peri-operative death from simultaneous urological and cardiac surgery for tumours involving the inferior vena cava (IVC)

2015 ◽  
Vol 14 (2) ◽  
pp. e816
Author(s):  
A. Fernando ◽  
S. Patel ◽  
K. Thomas ◽  
C. Austin ◽  
T.S. O'Brien
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Operative Death

scholarly journals Medical Management of Retained Inferior Vena Cava Filters

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4970-4970
Author(s):  
John Melson ◽  
Ian Crane ◽  
Leslie Ward ◽  
Surabhi Palkimas ◽  
Bethany Horton ◽  
...  
Keyword(s):  
High Risk ◽  
Inferior Vena Cava ◽  
Major Bleeding ◽  
Medical Management ◽  
Therapeutic Dose ◽  
Inferior Vena ◽  
Vena Cava ◽  
Event Analysis ◽  
Bleeding Events

Background Venous thromboembolism (VTE) is a common and often fatal medical event. VTE management often includes inferior vena cava filter (IVCF) placement when anticoagulation fails or is contraindicated. Controversial indications for IVCF placement include adjunctive treatment for deep vein thrombosis (DVT) without pulmonary embolism (PE) and VTE prophylaxis for high-risk patients (Deyoung and Minocha, 2016; Ho et al., 2019). Numerous device-associated mechanical and medical complications have been described (Ayad et al., 2019) and guidelines recommend early retrieval (Morales et al., 2013). There is limited evidence, however, to guide anticoagulation practices while IVCFs are retained. We aimed to characterize IVCF placement, retrieval, and interim medical management at our institution. Methods Retrospective chart review was performed for all patients who underwent IVCF placement at the University of Virginia Medical Center from January to December 2016. Data were collected from time of IVCF placement until either IVCF removal or 18 months post-placement, whichever occurred first. Indication for IVCF placement, baseline patient characteristics, IVCF complications, anticoagulation regimens, and bleeding and clotting events were identified. Baseline characteristics were recorded for all patients. Patients who did not survive the admission during which the IVCF was placed, underwent IVCF removal prior to discharge, or lacked adequate outpatient records during the period of IVCF retention were excluded from the event analysis cohort. Results IVCFs were placed in 140 patients during the study period (Table 1). A majority of patients were admitted to a surgical service, frequently following trauma (49 patients, 35%). IVCFs were placed for several indications, most commonly diagnosed VTE with a contraindication to anticoagulation (70 patients, 50%) and prophylaxis for high risk of VTE (44 patients, 31%). By the end of the study period, 88 patients (63%) had confirmed IVCF removal while 35 patients (25%) retained the IVCF for a clinical consideration. 33 patients (24%) lacking an adequately documented period of outpatient IVCF retention were excluded from the event analysis. Of the 107 patients included in the event analysis cohort, 76 patients (71%) underwent IVCF removal. Removal occurred >60 days after placement in 82% of these cases and median time to removal was 95 days (Table 2). Outpatient follow up and anticoagulation management varied widely, though 75 patients (70%) received a therapeutic dose anticoagulant during the period of IVCF retention and only 15 patients (14%) were not exposed to either a prophylactic or therapeutic dose anticoagulant. 50 patients (47%) had at least one regimen change. Bleeding and/or clotting events occurred for 15 patients (14%, Table 3). All 8 bleeding events occurred during anticoagulant exposure. Patients were exposed to a therapeutic dose anticoagulant during 4 of the 6 observed major or clinically relevant non-major bleeding events. Of the 12 observed clotting events, 8 occurred in the absence of anticoagulation. Isolated DVT was the most common clotting event (8 events in 7 patients, 7%) and IVCF thrombus was observed in 2 patients (2%). Bleeding and clotting events were observed in patients with a wide range of indications for IVCF placement, including patients whose IVCFs were placed prophylactically. Conclusions The optimal medical management of retained IVCFs is uncertain. This retrospective study characterizes IVCF placement, removal, and interim medical management for a diverse patient population at a single institution. Outpatient follow up varied widely and anticoagulant exposure during IVCF retention was inconsistent. Despite considerable anticoagulant exposure across the cohort, major bleeding events were infrequent. Thrombotic events, often in the absence of anticoagulation and potentially preventable, were more common. Standardization of medical management during IVCF retention would likely benefit this heterogeneous patient population at high risk of both bleeding and thrombotic complications. Ongoing statistical modeling for the study cohort will seek to inform anticoagulant decision making by assessing for associations between anticoagulant exposure and these clinical events. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prophylactic inferior vena cava filters in trauma patients at high risk: Follow-up examination and risk/benefit assessment

1999 ◽  
Vol 30 (3) ◽  
pp. 484-490 ◽  
Author(s):  
Eugene M. Langan ◽  
Richard S. Miller ◽  
William J. Casey ◽  
Christopher G. Carsten ◽  
Robin M. Graham ◽  
...  
Keyword(s):  
High Risk ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Benefit Assessment ◽  
Trauma Patients ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters ◽  
Risk Benefit Assessment

Experience of King Abdullah Medical City in Placement of Inferior Vena Cava Filter Prior to Bariatric Surgery in Extremely High-Risk Patients for Thromboembolic Events

2019 ◽  
Vol 30 (5) ◽  
pp. 2050-2052
Author(s):  
Bashar Babkour ◽  
Zeyad Alharbi ◽  
Sultan A. Almugbel ◽  
Abdulbasit S. Malibari ◽  
Muhjah Bukhari ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
High Risk ◽  
Inferior Vena Cava ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Vena Cava Filter ◽  
Thromboembolic Events ◽  
Medical City ◽  
Risk Patients

The Prophylactic Use of Inferior Vena Cava Filters in Patients Undergoing High-Risk Spinal Surgery

2005 ◽  
Vol 19 (3) ◽  
pp. 442-447 ◽  
Author(s):  
Luis Leon ◽  
Heron Rodriguez ◽  
Rabih G. Tawk ◽  
Stephen L. Ondra ◽  
Nicos Labropoulos ◽  
...  
Keyword(s):  
High Risk ◽  
Inferior Vena Cava ◽  
Spinal Surgery ◽  
Inferior Vena ◽  
Vena Cava ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters ◽  
Prophylactic Use

Usefulness of Serial Measurements of Inferior Vena Cava Diameter by Vscan TM to Identify Patients With Heart Failure at High Risk of Hospitalization

2017 ◽  
Vol 119 (10) ◽  
pp. 1631-1636 ◽  
Author(s):  
Raj M. Khandwalla ◽  
Kade T. Birkeland ◽  
Raymond Zimmer ◽  
Timothy D. Henry ◽  
Roland Nazarian ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Patients With Heart Failure ◽  
Inferior Vena Cava Diameter ◽  
Serial Measurements
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