Common Indications for IVC Filter Placement in Nigeria: Three Case Series

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Venous thromboembolism comprised Deep Venous Thrombosis (DVT) and pulmonary embolism (PE). It is a continuum of a single disease process within the veins which drain blood to the right sided heart and continue to the pulmonary artery. The 3 case series above had DVT with the 2nd case diagnosed with pulmonary embolism. Commonly, DVT develops within the deep veins of the lower extremities or pelvic region. But, it can also arise from upper extremities or devices such as pacemaker, implantable cardioverter defibrillators, cardiac Resynchronization therapy and long term tunnel dialysis catheters. Our 3 patients presented, had DVT of the lower extremities. Inferior vena cava filter is not part of the management plan for DVT from upper extremities and the cardiac devices. The most dreaded complication of DVT is pulmonary embolism. Pulmonary embolism is the frequent cause of death among patients with venous thromboembolism. One patient had pulmonary embolism among the 3 patients reported. Death is associated with serious underlying disease in approximately 50% of patients with pulmonary embolism. The main stay of DVT and pulmonary embolism is Systemic anticoagulation with intravenous heparin followed by oral warfarin or Non-Vitamin K antagonist oral anticoagulants (NOAC). However, as many as 33% of patients will develop a second PE while receiving adequate anticoagulation therapy. The second case reported developed pulmonary embolism while on oral anticoagulation. Also, anticoagulation therapy is associated with bleeding. This limit its use in certain groups of high-risk patients, including patients at high risk for falling, hemorrhagic stroke, metastastic disease, or bleeding diathesis. The first case was on warfarin after DVT. But he developed massive upper GI bleeding that necessitated 12 units of packed cell transfusion within 24 hours. The third patient had hemorrhagic stroke and while being managed in the hospital developed DVT.