title: The management of filter-related caval thrombosis complicated by heparin-induced thrombocytopenia and thrombosis.
abstract: This report evaluates the efficiency and safety of catheter-directed thrombolysis (CDT) using tissue plasminogen activator (tPA) and argatroban for the treatment of IVC filter thrombosis complicated by heparin-induced thrombocytopenia (HIT). From October 2012 to December 2014, 19 patients with unilateral lower extremity deep venous thrombosis were treated with standard anticoagulation, filter placement and urokinase-based CDT, all of whom developed IVC filter thrombosis and HIT. A revised protocol (tPA-based CDT and argatroban-based anticoagulation) was performed to treat IVC thrombosis. The extent of lysis was graded from I to III. Technical and clinical outcomes and complications were monitored. A total of 22 filters were implanted, 20 of which were retrieved later. The technical success rate of revised CDT for IVC thrombosis was 100%. On evaluating IVC thrombus, thirteen cases (68.4%, 13/19) were identified as grade III (complete resolution of thrombus) and six (31.6%, 6/19) as grade II (50-99% resolution of thrombus). No major bleeding related to CDT occurred. HIT in all patients was successfully treated with argatroban. Two patients with malignant tumor died during the follow-up. For patients with IVC filter thrombosis complicated by HIT, it seems tPA-based CDT and argatroban is an alternative regimen.
authors.affiliation: The Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University No. 68 Changle Road, Nanjing 210006, China ; The Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School No. 321, North Zhongshan Road, Nanjing 210008, China.
authors.forename: Wanyin
authors.initials: W
authors.lastname: Shi
authors.affiliation: The Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University No. 68 Changle Road, Nanjing 210006, China.
authors.forename: Wensheng
authors.initials: W
authors.lastname: Lou
authors.affiliation: The Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University No. 68 Changle Road, Nanjing 210006, China.
authors.forename: Xu
authors.initials: X
authors.lastname: He
authors.affiliation: The Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School No. 321, North Zhongshan Road, Nanjing 210008, China.
authors.forename: Changjian
authors.initials: C
authors.lastname: Liu
authors.affiliation: The Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University No. 68 Changle Road, Nanjing 210006, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Gu
keywords: Inferior vena cava filter; anticoagulation therapy; catheter-directed thrombolysis; venous thrombosis