Q: 54 year male in ICU with multi system organ failure (MSOF) get diagnosed with deep venous thrombosis (DVT). Patient had severe gastrointestinal (GI) bleed 2 days ago when he almost died. He is not eligible for travel to go for any further imaging due to high ventilator requirement. What is your next option? (Best answer) 

A) Start low dose IV Heparin and titrate slowly up 
B) IVC filter at bedside 
C) Observation and repeat bedside duplex in 24 hours
D) Start low dose SQ anticoagulation 
E) catheter directed thrombolysis


Answer: B

Out of all of the above IVC filter at bedside under fluoroscopy is the best option. If fluoroscopy is not available bedside ultrasound can be used. 

A, D and E are not appropriate choices due to life-threatening GI bleed in last 48 hours.

C is not a good choice when bedside IVC filter is available.



 Reference: 

 Uppal B, Flinn WR, Benjamin ME. The bedside insertion of inferior vena cava filters using ultrasound guidance. Perspect Vasc Surg Endovasc Ther 2007; 19:78.