Inferior vena cava thrombosis treatment

Inferior vena cava thrombosis (IVCТ) — is one of the most severe forms of venous obstruction in terms of clinical course and outcomes. First, venous thrombosis is an acute condition characterized by thrombus formation in the vein lumen associated with inflammation (thrombophlebitis) and impaired venous blood outflow. Three factors are necessary for the formation of a thrombus in a vein:

• slowing of blood flow;
• changes in blood composition and viscosity;
• damage to the vessel wall.

Treatment is aimed at eliminating these factors.

How IVCТ thrombosis is treated

Initial treatment involves the use of anticoagulants.

Heparin may be started in the emergency room and then switched to warfarin or a newer generation anticoagulant. Additional treatment options depend on the severity of the thrombosis.

A catheter-directed thrombolysis or thrombectomy may be of benefit if the thrombus in the IVCT is in the acute (less than 14 days), subacute (15 to 28 days) stage and in a patient who is not at high risk for bleeding.

Percutaneous transluminal angioplasty with stenting is also being considered.

However, for prolonged (more than 28 days) thrombosis of the IVCT, stenting may be more beneficial than catheter thrombolysis.

When evaluating the patient in the emergency department, the initiation of heparin administration is critical. A vascular surgeon should be consulted for other treatment options. If the cause of IVCT thrombosis is an “external” cause, such as a tumor, additional diagnostic tests should be performed.