How would a patient with both deep vein thrombosis and chronic subdural hematoma be treated?
Now, I don’t mean someone who develops a chronic subdural hematoma from the Coumadin (Warfarin) they were prescribed to treat a DVT.
Rather, I mean a new-onset deep vein thrombosis which is unrelated to the symptomatic chronic subdural hematoma.
The patient has risk factors for DVT, such as smoking, lack of exercise, pregnancy or being on birth control pills, a recent joint replacement surgery and recent prolonged air travel.
The chronic subdural hematoma developed as a result of slipping on ice several weeks prior and hitting the head against concrete.
“These types of clinical situations require a close discussion between the doctors,” says Kevin Casey, MD, FACS, a vascular surgeon with West Coast Vascular.
“This patient would likely be a good candidate for an (inferior vena cava) IVC filter. This is a small ‘umbrella’-like device which is placed in the IVC.”
The filter “does not prevent the development or propagation of DVTs, but it prevents them from traveling to the lungs and becoming a PE.”
Think of a fish net trapping fish.The IVC is a large vein that leads into the heart.
“An indication for an IVC filter is a contraindication to anticoagulation (as this patient likely would be), allergy to anticoagulation, or development of a new VTE while on therapeutic anticoagulation.”
A chronic subdural hematoma is slow bleeding in the brain, usually caused by impact to the head that creates small tears in the bridging veins near the skull.
It can take up to 12 weeks before symptoms begin appearing, due to the slow nature of the bleeding.
Anticoagulation (anti-clotting) drugs would thin out the blood, which in turn would amplify the bleeding in the brain.
My mother had a DVT and a chronic subdural hematoma — about two and a half months apart, but they could have been concurrent, simply because there had been no reason why they could not have been concurrent. She was lucky in that respect.
What about pulmonary embolism simultaneous with chronic subdural hematoma?
Simultaneous with a chronic subdural hematoma (not acute) — one that’s generating symptoms such as a “crown of thorns” headache, weakness on one side of the body and changes in cognition.
As for the course of treatment for this kind of situation, Dr. Casey explains: “Again, we would have to have a very close discussion about the best options for this patient.
“However, I think that an IVC filter may also serve this patient best.”
The IVC filter would prevent any additional PEs, but would not dissolve the PE that’s already there.
Dr. Casey specializes in vascular and vein therapy, and has been the lead researcher on publications examining abdominal aortic aneurysms, carotid artery disease and lower extremity critical limb ischemia.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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