Thrombophilia surgery: Difference between revisions
Jump to navigation
Jump to search
| Line 14: | Line 14: | ||
*Patients with inherited thrombophilia who undergo surgery should generally be treated as a high-risk group and receive prophylactic periperative anticoagulation with LMWH. | *Patients with inherited thrombophilia who undergo surgery should generally be treated as a high-risk group and receive prophylactic periperative anticoagulation with LMWH. | ||
**Antithrombin deficiency: Surgery is associated with a reduction in antithrombin levels for 3–5 days postoperatively and some patients with antithrombin deficiency and low concentrations of antithrombin may not respond well to heparin. For this reason and to reduce the risk of bleeding from anticoagulation, antithrombin concentrate has been used successfully in several case reports and studies. | **Antithrombin deficiency: Surgery is associated with a reduction in antithrombin levels for 3–5 days postoperatively and some patients with antithrombin deficiency and low concentrations of antithrombin may not respond well to heparin. For this reason and to reduce the risk of bleeding from anticoagulation, antithrombin concentrate has been used successfully in several case reports and studies. | ||
*Apart from pharmacological management, endovascular treatment is also used in some facilities to manage thrombosis. It is reported to be more successful if the thrombus is truly acute (i.e., formation two weeks before the presentation). Different endovascular methods include catheter-directed thrombolysis, percutaneous aspiration thrombectomy, venous balloon dilatation, pharmacomechanical catheter-directed thrombolysis. The use of '''inferior vena cava (IVC) filters''' remains controversial in the acute setting and should only be considered in select cases. IVC filters carry their own risk of potential complications, and they can serve as a nidus for thrombus formation. In general, for acute venous thrombosis, the use of IVC filters should be avoided unless there is an absolute contraindication to anticoagulation or severe active bleeding. When used, a retrievable type of IVC filter is preferred, and anticoagulation should be offered as soon as safely feasible. | |||
==References== | ==References== | ||
Revision as of 17:10, 7 March 2021
|
Thrombophilia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Thrombophilia surgery On the Web |
|
American Roentgen Ray Society Images of Thrombophilia surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asiri Ediriwickrema, M.D., M.H.S. [2]
Overview
Surgery is not required for treatment for thrombophilia. IVC filter placement may be indicated if the patient has contraindications to or complications from anticoagulation, recurrent thrombosis on anticoagulation, or failure to acheive therapeutic anticoagulation levels.[1]
Surgery
- Surgery is not required for treatment for thrombophilia
- IVC filter placement may be indicated in certain scenarios:
- Contraindications to or complications from anticoagulation
- Recurrent thrombosis on anticoagulation, or failure to acheive therapeutic anticoagulation levels
- Patients with inherited thrombophilia who undergo surgery should generally be treated as a high-risk group and receive prophylactic periperative anticoagulation with LMWH.
- Antithrombin deficiency: Surgery is associated with a reduction in antithrombin levels for 3–5 days postoperatively and some patients with antithrombin deficiency and low concentrations of antithrombin may not respond well to heparin. For this reason and to reduce the risk of bleeding from anticoagulation, antithrombin concentrate has been used successfully in several case reports and studies.
- Apart from pharmacological management, endovascular treatment is also used in some facilities to manage thrombosis. It is reported to be more successful if the thrombus is truly acute (i.e., formation two weeks before the presentation). Different endovascular methods include catheter-directed thrombolysis, percutaneous aspiration thrombectomy, venous balloon dilatation, pharmacomechanical catheter-directed thrombolysis. The use of inferior vena cava (IVC) filters remains controversial in the acute setting and should only be considered in select cases. IVC filters carry their own risk of potential complications, and they can serve as a nidus for thrombus formation. In general, for acute venous thrombosis, the use of IVC filters should be avoided unless there is an absolute contraindication to anticoagulation or severe active bleeding. When used, a retrievable type of IVC filter is preferred, and anticoagulation should be offered as soon as safely feasible.
References
- ↑ Inferior Vena Cava Filters. Medscape (2015). URL Accessed on July 17, 2016