It has been proven that the use of an
inferior vena cava filter (IVCF) is effective in decreasing the incidence of
pulmonary embolism (PE) in high-risk spinal surgery patients. A case of fatal PE after spinal surgery in a 78-year-old woman who had a history of
pulmonary hypertension due to peripheral PE treated with a permanent IVCF and
anticoagulant therapy for 3 years is reported. The patient had experienced an episode of recurrent PE during the withdrawal of
anticoagulants, but she had uneventfully undergone two
orthopedic surgeries with a preoperative
unfractionated heparin infusion instead of oral
warfarin. Three months after the second operation, she underwent posterior lumbar
spinal fusion. The following morning, she suddenly complained of chest discomfort and
dyspnea with SpO(2) 78 %. An electrocardiogram showed a
right bundle branch block. Then, 30 min later, she suddenly lost consciousness, and her carotid pulse was not palpable. The patient died 2 h and 30 min after onset. Acute PE probably occurred because of a massive
thrombus above the IVCF. This case suggests that the efficacy of long- term use of a permanent IVCF is limited in cases when
anticoagulants must be withdrawn, such as for
orthopedic surgery.