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Thread: IVC Filter - coumadin?

  1. #1

    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.


  2. #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).

    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.


  3. #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.

  4. #4

    Anyone with a filter?

    Anyone? Anyone?....

  5. #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.

  6. #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.

  7. #7
    Quote 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.
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  8. #8
    Senior Member smokey's Avatar
    Join Date
    Jul 2001
    Massachusetts, USA
    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.

  9. #9
    Senior Member
    Join Date
    Mar 2006
    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

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

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