Category: Clinical Sciences/Health Conditions
Pulmonary embolism and acute deep venous thrombosis in a GBM patient after dual inferior vena cava (IVC) filter placement
A 50 year old gentleman with IVC duplication, GBM, seizure disorder, thrombocytopenia, and subdural hemorrhage presented for inpatient rehabilitation with left-sided weakness and cognitive impairments after repeat craniotomy, tumor resection, and dual IVC filter placement. After filter placement, the patient was instructed to avoid strenuous activity, heavy lifting, and bending at the waist. Shortly after admission, he developed unilateral left leg edema and was diagnosed with acute deep vein thromboses of the femoral, popliteal, gastrocnemius, and peroneal veins. Two weeks later, he developed pleuritic chest pain, requiring transfer to an acute care hospital. CT angiogram showed acute and chronic pulmonary emboli (PE). He was treated with intravenous heparin and transitioned to subcutaneous enoxaparin. He was transferred back to complete therapy and was discharged home without further complications.
VTE can cause significant disability due to pain, edema, and decreased mobility. Patients with intracranial malignancy are considered poor candidates for VTE chemoprophylaxis due to effects of chemotherapy, radiation, and surgery. In this case, dual IVC filters were placed due to recent surgery and thrombocytopenia. Complications of IVC filter placement in patients with intracranial malignancy include PE, recurrent venous thrombosis, and postphlebitic syndrome. This is particularly important for cancer patients undergoing inpatient rehabilitation, where they are engaging in physical activity. Computational models suggest that exercise may promote propagation of thrombus along the IVC. His duplicated IVC may have further contributed to multiple pulmonary emboli.
VTE poses a significant risk for patients with intracranial malignancy. Despite frequent use of IVC filters, complication rates are high. The utility of an IVC filter may be lower for patients engaging in intense physical activity. This should be taken into consideration when treating VTE in the inpatient rehabilitation population.