Treatment-resistant venous thrombosis and pulmonary embolism in a patient with granulomatosis with polyangiitis: a case report

Abstract Background We herein present a case of venous thrombosis that developed more than 20 years after diagnosis of granulomatosis with polyangiitis (GPA), although many reports of GPA have described venous thrombosis within 1 year of diagnosis. Case presentation A 73-year-old man with GPA was admitted for lower extremity swelling and diagnosed with venous thrombosis and pulmonary embolism. On the second day, catheter-based thrombolysis was unsuccessful, and inferior vena cava filter insertion and anticoagulation were performed. On the third day, respiratory disturbance and loss of consciousness appeared and progressed. The patient died on the fifth day. The autopsy revealed a large thrombus in the inferior vena cava filter, and death of progressive venous thrombosis was suspected. Conclusions We experienced a case of venous thrombosis that developed 20 years after diagnosis of GPA, although GPA is frequently associated with venous thrombosis immediately after diagnosis. The thrombosis progressed rapidly and was resistant to treatment.

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Inferior Vena Cava Filter Placement during Pregnancy: An Adjuvant Option When Medical Therapy Fails

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/821635 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Sara Valadares ◽

Fátima Serrano ◽

Rita Torres ◽

Augusta Borges

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter ◽

Filter Placement ◽

Thrombotic Risk

The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy.

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Experience with the Cardial inferior vena cava filter as prophylaxis against pulmonary embolism in pregnant women with extensive deep venous thrombosis

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.1992.tb13871.x ◽

1992 ◽

Vol 99 (9) ◽

pp. 726-726 ◽

Cited By ~ 1

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Pregnant Women ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter

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Prophylactic placement of inferior vena cava filters and the risk of death or venous thromboembolism in severe trauma patients: a retrospective study comparing two hospitals with different approaches

Acta Radiologica Open ◽

10.1177/2058460121999345 ◽

2021 ◽

Vol 10 (3) ◽

pp. 205846012199934

Author(s):

Thien Trung Tran ◽

Haraldur Bjarnason ◽

Jennifer McDonald ◽

Nils Oddvar Skaga ◽

Damon E Houghton ◽

...

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter ◽

Filter Placement ◽

Inferior Vena Cava Filters ◽

Vena Cava Filters

Background Prophylactic use of inferior vena cava filters to prevent pulmonary embolism in trauma is controversial. The practice varies between hospitals and countries, in part due to conflicting evidence and guidelines. Purpose To compare the effects of pulmonary embolism, deep venous thrombosis and mortality in two hospitals using prophylactic inferior vena cava filter placement or prophylactic anticoagulation alone. Material and Methods Patients presenting with severe trauma were recruited from two level-1 trauma centres between January 2008 and December 2013. Recruited patients from an US hospital having prophylactic inferior vena cava filter inserted were compared to a Scandinavian hospital using prophylactic anticoagulation alone. Inclusion criteria were age >15 years, Injury Severity Score >15 and survival >24 h after hospital admission. Patients with venous thromboembolism diagnosed prior to inferior vena cava filter placement were excluded. A Cox proportional hazard regression model was used with adjustment for immortal time bias and predictor variables. Results In total, 951 patients were reviewed, 282 from an US hospital having inferior vena cava filters placed and 669 from a Scandinavian hospital without inferior vena cava filters. The mean age was 45.9 vs. 47.4 years and the mean Injury Severity Score was 29.8 vs. 25.9, respectively. Inferior vena cava filter placement was not associated with the hazard of pulmonary embolism (Hazard ratio=0.43; 95% confidence interval (CI) 0.12, 1.45; P=0.17) or mortality (Hazard ratio=1.16; 95% CI 0.70, 1.95; P=0.56). However, an increased rate of deep venous thrombosis was observed with inferior vena cava filters in place (Hazard ratio=3.75; 95% CI 1.68, 8.36; P=0.001). Conclusion In severely injured trauma patients, prophylactic inferior vena cava filter placement was not associated with pulmonary embolism or mortality. However, inferior vena cava filters were associated with increased rate of deep venous thrombosis.

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Retrievable inferior vena cava filter to prevent pulmonary embolism in patients with fractures and deep venous thrombosis of lower extremities: a single-center experience

Journal of International Medical Research ◽

10.1177/03000605211006591 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110065

Author(s):

Junjie Huang ◽

Xiangchen Dai ◽

Xiujun Zhang ◽

Junhai Li ◽

Mei Huang ◽

...

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Orthopedic Surgery ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter ◽

Significant Difference

Objective To evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery. Methods Clinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups. Results An IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups. Conclusions Retrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a <1-cm thrombus than does AKDVT.

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