The combination of low dose unfractionated heparin and an inferior vena cava filter may be a safe and effective strategy for managing acute pulmonary thromboembolism in patients undergoing medical treatment for acute aortic dissection.
May support low-dose heparin plus IVC filter in select cases; hypothesis-generating and requires prospective validation.
A 71-year-old woman was admitted with Stanford type A acute aortic dissection (AAD). Computed tomography (CT) revealed thrombosis of the false lumen, and we planned to treat medically. She developed transient pleural effusion and hypoxemia, which persisted despite her pleural effusion disappeared. We performed CT and found a large thrombus in the pulmonary artery and femoral vein. We administered low dose- unfractionated heparin and installed a retrievable inferior vena cava filter, which caused the thrombus in the pulmonary artery to disappeared without exacerbating AAD. Our strategy seems to be suitable for acute pulmonary thromboembolism that occurs during the treatment of AAD.
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Kagawa et al. (2015) studied this question.
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