A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis

Décousus, Hervé; Leizorovicz, Alain; Parent, Florence; Page, Yves; Tardy, Bernard; Girard, Philippe; Laporte, Silvy; Faivre, R.; Charbonnier, B; Barral, Fabrice-Guy; Huet, Y.; Simonneau, Gérald

doi:10.1056/nejm199802123380701

Cited by 1,582 publications

(786 citation statements)

References 21 publications

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“…In this cohort of postarthroplasty patients, the incidence of major bleeding complications (10%) was substantially higher than the rates reported for nonsurgical patients, which are 0% to 5% [5,20,22,35]. This difference highlights the unique risks inherent to anticoagulation treatment in patients who have undergone procedures, which include substantial soft tissue dissection and osteotomies.…”

Section: Discussionmentioning

confidence: 62%

“…Because the risk of developing PE is greatest in close proximity to surgery, the treating surgeon is faced with starting aggressive, potent anticoagulation at a time when the risk of bleeding from the surgical site is highest [12]. Major surgical site bleeding increases the risk of neurologic damage [4,5] and reoperation [7], delays recovery [16,25], and increases the risk of infection by 12.3% [31]. Potentially fatal bleeding can also occur in other organ systems [19,29].…”

Section: Introductionmentioning

confidence: 99%

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High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Neviaser

Chang

Lyman

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Neviaser

Chang

Lyman

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Inferior vena cava filter retrievals, standard and novel techniques showed a statistically significant increase in the incidence of lower-extremity deep venous thrombosis in patients in whom IVC filters were implanted as compared to control patients (8). Based upon these and other findings, the U.S. Food and Drug Administration (FDA) issued a safety alert in 2014 recommending IVC filter removal as soon as is clinically appropriate and shared the responsibility of filter removal equally between the implanting physician and the clinician responsible for the ongoing care of patients in whom a retrievable IVC filter has been placed (9).…”

Section: Review Articlementioning

confidence: 99%

“…Cardiovasc Diagn Ther 2016;6(6):642-650 cdt.amegroups.com loops such as the duodenum, aortic wall penetration, and small-bowel volvulus. Filter migration and spontaneous fracture and embolization of filter components have also been reported (8,10,14,27,28). Nonetheless, before using advanced techniques for IVC filter retrieval, the associated possible complications should always be compared to the potential risks of leaving the filter permanently indwelling, and should be individualized.…”

Section: Complications Of Ivc Filter Retrievalsmentioning

confidence: 99%

Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

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Abstract:The placement of an inferior vena cava (IVC) filter is a well-established management strategy for patients with venous thromboembolism (VTE) disease in whom anticoagulant therapy is either contraindicated or has failed. IVC filters may also be placed for VTE prophylaxis in certain circumstances.There has been a tremendous growth in placement of retrievable IVC filters in the past decade yet the majority of the devices are not removed. Unretrieved IVC filters have several well-known complications that increase in frequency as the filter dwell time increases. These complications include caval wall penetration, filter fracture or migration, caval thrombosis and an increased risk for lower extremity deep vein thrombosis (DVT). Difficulty is sometimes encountered when attempting to retrieve indwelling filters, mainly because of either abnormal filter positioning or endothelization of filter components that are in contact with the IVC wall, thereby causing the filter to become embedded. The length of time that a filter remains indwelling also impacts the retrieval rate, as increased dwell times are associated with more difficult retrievals. Several techniques for difficult retrievals have been described in the medical literature. These techniques range from modifications of standard retrieval techniques to much more complex interventions. Complications related to complex retrievals are more common than those associated with standard retrieval techniques. The risks of complex filter retrievals should be compared with those of life-long anticoagulation associated with an unretrieved filter, and should be individualized. This article summarizes current techniques for IVC filter retrieval from a clinical point of view, with an emphasis on advanced retrieval techniques.

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“…Complications associated with anticoagulation in the TJA population include bleeding, postoperative infection, a higher rate of blood product transfusion, and drug thrombocytopenia. Surgical site bleeding increases the risk of neurologic damage, infection, reoperation, and delays recovery [5,7,14,17,25,26]. Neviaser et al found that postoperative therapeutic enoxaparin treatment had a 10% rate of major and a 27% rate of minor bleeding complications in TJA patients [21].…”

Section: Discussionmentioning

confidence: 99%