Benefit vs. Risk of a Permanent Inferior Vena Cava Filter in Pulmonary Embolism with Anticoagulation Contraindication

Cases of pulmonary embolism (PE) with contraindication of anticoagulation have low incidence. Under these circumstances the placement of an inferior vena cava (IVC) filter may be life-saving. Paradoxically, the presence of the filter imposes anticoagulation itself, due to the risk of filter thrombosis, promoting stasis and increasing the risk of filter related deep venous thrombosis (DVT) and PE recurrence by means of a substantial collateral venous return that bypasses the IVC filter (1,2). We present the case of a woman with DVT, complicated with high risk PE. After thrombolysis with alteplase the patient develops retroperitoneal hematoma originating from undiagnosed renal angiomyolipoma. Therefore long term anticoagulation is considered contraindicated and an IVC filter is installed. Shortly after hospital release the patient presents occlusion of the IVC filter with DVT recurrence. The initiation of low molecular weight heparin and afterwards of acenocumarol has a favorable outcome, and after six months of follow up the patient is completely recovered.