The clinical implications of acute thrombosis of the inferior vena cava

A review of the clinical records of 25 patients with IVC thrombus, proved by cavography during a ten year period, showed that this form of venous thrombosis accounted for less than 5 per cent of all phlebographically documented DVT at this institution. Before phlebography was performed, only eight patients (32 per cent) were suspected clinically of having IVC thrombus because of the absence of classic signs of bilateral lower extremity edema and pain in the majority of patients. Five patients presented with an acute PE, one being fatal. The majority of patients, 19 of 25 (80 per cent), had IVC thrombus contiguous with either iliofemoral (eight patients) or infrainguinal (11 patients) DVT. Nineteen patients were given anticoagulation therapy with heparin, and three patients underwent IVC compartmentalization. No subsequent PE developed in either group. Despite the potential for large lethal PE, heparin therapy appears to be the appropriate form of treatment for patients with IVC thrombus.