Experience with Greenfield Filters in Pregnant Women for Deep Venous Thrombosis and Pulmonary Embolism Case Reports

The indications for inferior vena caval filter placement in the gravid female are ill defined. During pregnancy, however, pulmonary embolism (PE) secondary to venous thrombosis is the most common cause of maternal mortality. Pregnant women are at risk for deep venous thrombosis (DVT) due to hypercoagulability caused by increased levels of coagulation factors and decreased fibrinolytic activity. In addition, decreased venous tone and velocity of blood flow in the lower extremities lead to venous stasis. Although heparin is the treatment of choice for DVT associated with pregnancy, propagation of thrombus or development of bleeding diathesis mandates discontinuation of anticoagulant therapy and consideration for caval interruption. In this review, two patients are presented who required vena caval filters during pregnancy, and indications for their usage in this patient population are defined. Filter placement is recommended during pregnancy in the presence of extensive iliofemoral thrombus, free-floating thrombus, bleeding complications, or pulmonary embolism despite adequate anticoagulation.