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    IVC Filter - coumadin?

    Do any of you have an IVC (inferior vena cava) Filter?

    If so, are you on the blood thinner coumadin "for life"?

    Did you have a DVT (deep vein thrombosis = blood clot) in your leg, and then your doctors decided to put an IVC filter in to protect you from a PE (pulmonary embolism)?

    Or did your doctors insert the IVC filter soon after your accident to help protect you, in case you developed a DVT in the future, from further complications?
    ---------------------------------------------------------------------------------------------------------------

    You don't need to read any further unless you are interested in DVTs and related stuff......

    Patients in the intensive care unit are often at high risk of developing blood clots in their legs. These are a bad thing because sometimes a piece of the blood clot breaks off and floats through the bloodstream up to the heart/lungs, and can get lodged in a blood vessel going to the lung. This is called a pulmonary embolism. A blockage in a blood vessel to the lung can put a large strain on the heart and lungs, and can be fatal. Not good.

    To try to prevent blood clots from happening, hospitals have become more vigilant and put patients on a low dose of a blood thinner to try to prevent blood clots from happening. Often they use ted hose/compression stockings or those annoying alternating compression boots that help the blood in the venous system move back up through the legs and back to the heart (and may prevent blood clots through other mechanisms as well).

    There are some patients that are extremely high risk for forming blood clots. These include trauma patients, post-surgical patients (especially after an orthopedic surgery - like a spine surgery or a hip replacement), and patients with acute spinal cord injury among others.

    When my dad was hit by a taxi he had multiple fractures as well as a spinal cord injury. He was in the ICU and was considered to be very high risk for having a blood clot since he had all of those high risk factors listed above. And unfortunately they couldn't use any blood thinners to try to protect him since he was bleeding in many places (including the brain) and was going in and out of surgery.

    I suspect there were a few of you in a similar position after your accident, if you were involved in a trauma.

    So the doctors decided to place an IVC filter in him to protect him from the possible complication of a PE, since the chance of him getting a DVT was so high. This decision is still a little controversial, but as best as I can tell it is being done more and more at experienced medical centers.

    An IVC filter is basically like a sieve that sits in your vena cava (the big blood vessel that drains blood from your legs back to your heart), and in theory, would "catch" any small blood clots that might form/dislodge before they reach your heart.

    As expected, my father was discovered to have a huge DVT in his leg a couple weeks later. He never developed any complications from it (like a PE), likely because of the IVC filter. By the time the DVT was discovered, it was safe for him to be placed one of the strong blood thinners that are used to treat DVTs (Lovenox). He was continued on coumadin (or the equivalent) for 6 months.

    The question now that is being discussed among his doctors is how long anti-coagulation (ie coumadin or lovenox) should be continued. Does he need to be on coumadin for the rest of his life, or is he done? It turns out the presence of an IVC filter in your body actually increases your chances of getting another blood clot in the future (!bad luck...), and also having a DVT once increases your chances of having another one, and perhaps having a spinal cord injury and being less mobile increases your risk as well.

    The answer is not clear, and there are pros and cons, as blood thinners are not without risk/difficulties. Basically, we have gotten like 6 different answers from his 6 different doctors. I think we have decided what to do, but we were most curious what others with spinal cord injury and IVC filters have been advised? Of course, most of my dad's doctors are not familiar with spinal cord injury and its associated issues.

    thanks!

    #2
    First of all, please do NOT post entire articles from other sources here. This is a violation of copyright and can get this site in trouble. When you want to reference an on-line article, quote one or two paragraphs only, and then the link. All such materials MUST be referenced.

    There are already clinical practice guidelines from the Consortium for Spinal Cord Medicine for DVT prevention specific to SCI. Both prevention and treatment vary a bit from that of the general ICU or hospitalized patient. IVC filters are not recommended routinely but are often placed in major trauma centers anyway (I think there are vascular surgeons making a bundle off of this). Preventive prophylaxis should be low molecular weight heparin, in addition to the IVC. IVCs should be used routinely only in those who cannot take the LMWH for some reason, or who are at extremely high risk in spite of the LMWH (high tetraplegics primarily).

    http://www.pva.org/site/News2?page=NewsArticle&id=7659

    If you actually develop a DVT in spite of these precautions, or if the precautions were not done, then Coumadin (warfarin) is indicated, and should be continued for a minimum of 6-12 months post-DVT. Some continue them longer or indefinitely.

    Even with an IVC, anticoagulation prophylaxis and treatment are indicated with LMWH and/or Coumadin. Aspirin is not appropriate, and even though an IVC may prevent a major pulmonary embolus, it will not prevent small ones, can get clogged with clots, and long term phlebotic syndrome cause be a real problem if a DVT develops below the filter.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


      #3
      Thank you KLD. I appreciate your thoughts.

      Sorry if you thought I posted an article, but I didn't! It's all my own writing, explaining our situation. Thought you could tell from my bad grammar.... A compilation of my own knowledge from many years/experience.... I'm sorry. I wont do it again. I'll only ask questions. Sorry. Ouch.

      Yes, the Consortium recommendations are very useful, but they don't address the long term anti-coagulation problem so well for our situation. And your suggestions (6-12 months.... some continue longer or indefinitely!) also mirror the variable advice we are being given - ??? It's a tough question I guess.

      The dilemma with using low molecular weight heparin (LMWH) acutely was clear in my father's situation. He had at least 12 operations over the first 3 weeks, and had bleeding from many sites, so the doctors were quite leary about restarting the LMWH. I bugged them daily about restarting it, and I think their delays were often reasonable. After one surgery when they restarted his LMWH, he had a huge bleed into his thigh and his hematocrit dropped to 20. That huge hematoma went on to be a big impediment to his comfort/rehab. In his situation, I suspect his IVC filter was the right thing to do. However, I suspect that you are right and that filters are not being placed in some patients for the right reasons.

      Anti-coagulation long term is a whole different beast.

      We may settle on a compromise of half dose lovenox (one of the low molecular weight heparins) We had a very difficult time stabilizing his coumadin dose, and his fall risk is very high these days.

      Comment


        #4
        Anyone with a filter?

        Anyone? Anyone?....

        Comment


          #5
          Here! They put a filter in me immediately after my injury, before they even went in and fixed my spine. I did develop a huge DVT in my leg a couple months later, and we were all relieved that I already had a filter in place. I took coumadin for nine months after the DVT. Note that they did give me the option to have the filter removed [before the DVT] and I considered it... glad I left it it!

          Thanks for the article! Well written.

          Comment


            #6
            I have a filter and it was put in within a few days of my injury. I did not have a blood clot at the time. I have been on Coumadin therapy for about six years now and I have had two DVT's in those six years but both came after coming off of the Coumadin thinking it was safe to do so. One was in my groin area and the other was my lower leg.

            Comment


              #7
              Originally posted by hlh View Post
              Anyone? Anyone?....
              I had mine put in waaay post after developing a clot from birth control pills.

              Dr. stopped the coumadin @ 6 months after.
              Get involved in politics as if your life depended on it, because it does. -- Justin Dart

              I shall not tolerate ignorance or hate speech on this site.

              Comment


                #8
                hlh, I had an IVC clip put in my vena cava in 1977. It is the Adams-DeWeese model. I had a couple episodes of shooting PE's in which I stopped breathing so they put in the clip. It was about 2 weeks after I was injured. I am not on any blood thinners.

                Comment


                  #9
                  I had one put in w/in days of my injury. I had serious bilateral blood clots about 2 years ago, and as I understand it the filter was the difference between a serious issue and a critical one. I was on coumadin for about 9 months. If I get another clot, the coumadin will be permanent.
                  T7-8 since Feb 2005

                  Comment


                    #10
                    I had one installed when first injured as a precaution.

                    Comment


                      #11
                      Thank you so much for your replies!

                      It looks like most of you aren't on coumadin anymore - even if you have had blood clots since putting in the filter. Only HealthQuad is still on it, I think. Zero, did you stop the coumadin? Jaycue?

                      This surprises me a little, but also makes me feel a little better as I struggle with what to do for my dad.

                      I hope DVTs/PEs are in the past for all of you. Please let us know if you ever have problems with your filters/DVTs in the future.

                      Thank you for your input.

                      hlh

                      Comment


                        #12
                        I also had a filter put in at the time of my injury. Developed blood clots a couple years later that my doctor actually blamed on the filter. One year later and still on the Coumadin.

                        Comment


                          #13
                          thanks Bspill

                          Ahhh....

                          Yes, this is my fear.

                          For those of you who developed blood clots after your filter was placed, did your doctors also suspect the filter was contributing? Or were there other causes at play?

                          Since the filter slows down the movement of blood out of your legs going back to your heart, it does make sense that it could increase the risk of blood clots in your legs.

                          Are many of you with filters struggling with peripheral edema (ie. swollen feet)? This is another sign that the filter is slowing down the return of blood out of your venous system in your legs back to your heart.

                          My dad has pretty significant peripheral edema if he doesn't wear pretty high compression compression stockings. They are a pain in the ass to put on, but I suspect they are decreasing his risk of more blood clots. And his feet turn a nasty purple without them.....

                          Comment


                            #14
                            I had 1 clot in 2002 after the filter was in. Coumadin for 6 months, then an asprin once a day for a few months. No blood thinners at all now.

                            Comment


                              #15
                              IVC Filter

                              I had an IVC filter put in in Sept 2007. I had a massive pulmonary saddle embolism. I also had DVT's in my right leg. My doctor said I will be on coumadin for the rest of my life. It is a real hardship whenever I need a procedure done. I had to have cortisone shots in my back this past summer and had to go on lovenox the week bofore each procedure. The lovenox shots bruise me so bad and make my stomach hurt for a month afterwards, not to mention how costly they are. I would really love to have the filter removed. Anyone know anyone who had one removed?
                              Or does anyone have information on what the long term prognosis of having an IVC filter is?

                              Thanks for any information you can give me.

                              Comment

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