Between a Clot and a Scarred Place

摘要

Immobilized orthopedic trauma patients face an elevated risk of venous thromboembolism (VTE). We present a case in which a patient undergoing staged repair of traumatic orthopedic injuries developed deep venous thrombosis (DVT) during hospitalization, prior to repair of a lower extremity injury for which delay in operation might result in poor functional outcome. We provide an overview of recommendations regarding pharmacologic prophylaxis of VTE in orthopedic patients. We review the importance of cultivating a high index of suspicion for VTE in such patients, even when receiving appropriate prophylaxis and lacking overt symptoms. Finally, we outline the multidisciplinary decision-making process regarding optimizing care for the patient in a precarious position of developing acute VTE while awaiting urgent surgery. Specifically, we review the safety, efficacy, and management of retrievable inferior vena cava filters (rIVCF) for this population.