Inferior vena cava thrombus due to hyperhomocysteinemia

Area of Science:

• Cardiovascular Medicine
• Hematology
• Nutritional Science

Background:

• Inferior vena cava (IVC) filters are used to prevent pulmonary embolism in patients with venous thromboembolism.
• Filter retrieval is a common procedure, but complications can occur.
• Hyperhomocysteinemia is a recognized risk factor for both arterial and venous thrombosis.

Observation:

• A 39-year-old man developed recurrent IVC thrombus after the removal of an IVC filter.
• The thrombus increased despite adequate anticoagulant therapy with warfarin.
• Systemic evaluation revealed severe hyperhomocysteinemia due to dietary deficiencies in folic acid and vitamin B12.

Findings:

• Treatment with folic acid and B vitamins, alongside warfarin, led to significant resolution of the IVC thrombus.
• Computed tomography (CT) also identified severe IVC stenosis below the renal veins.
• The patient experienced improvement in leg swelling and had no recurrent thrombus at 6 months.

Implications:

• Hyperhomocysteinemia should be considered in cases of recurrent venous thromboembolism, especially when anticoagulation is insufficient.
• Dietary assessment and supplementation with B vitamins and folic acid can be effective in managing hyperhomocysteinemia-related thrombosis.
• This case underscores the importance of investigating metabolic risk factors in patients with complex venous thromboembolic events.