Thrombophilia surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asiri Ediriwickrema, M.D., M.H.S. [2]

Overview

Surgery is not required for treatment for thrombophilia. IVC filter placement may be indicated if the patient has contraindications to or complications from anticoagulation, recurrent thrombosis on anticoagulation, or failure to acheive therapeutic anticoagulation levels.

Surgery

• Surgery is not required for treatment for thrombophilia
• IVC filter placement may be indicated in certain scenarios:
  • Contraindications to or complications from anticoagulation
  • Recurrent thrombosis on anticoagulation, or failure to acheive therapeutic anticoagulation levels

• Patients with inherited thrombophilia who undergo surgery should generally be treated as a high-risk group and receive prophylactic periperative anticoagulation with LMWH.
  • Antithrombin deficiency: Surgery is associated with a reduction in antithrombin levels for 3–5 days postoperatively and some patients with antithrombin deficiency and low concentrations of antithrombin may not respond well to heparin. For this reason and to reduce the risk of bleeding from anticoagulation, antithrombin concentrate has been used successfully in several case reports and studies.