Guidelines and the use of inferior vena cava filters: a review of an institutional experience

Abstract

Summary. Background and objectives: Based on the American College of Chest Physicians 2004 antithrombotic therapy for venous thromboembolism (VTE) and the Eastern Association for the Surgery of Trauma 2002 guidelines, placement of an inferior vena cava (IVC) filter is indicated in patients who either have, or are at high risk for, VTE, but have a contraindication or failure of anticoagulation. Our aim is to compare clinical characteristics and outcomes of patients receiving IVC filters within‐guidelines (WG) and outside‐of‐guidelines (OOG). Methods: The 558 patients who received an IVC filter were divided into two groups called WG or OOG. The WG group met the criteria described above and the OOG group did not have a contraindication to or a failure of anticoagulation. Results: The WG group had 362 patients and the OOG group had 196 patients. The OOG group had one (0.5%) patient with post‐filter pulmonary embolism (PE), two (1%) with IVC thrombosis, and seven (3.6%) with deep vein thrombosis (DVT). The WG group had five (1.4%) patients with post‐filter PE, 13 (3.6%) with IVC thrombosis, and 34 (9.4%) with DVT. All patients who developed post‐filter PE had a DVT before filter placement, and patients who did not have a prior VTE event were at a significantly lower risk of developing post‐filter IVC thrombosis and PE. Conclusion: Our data do not support the use of an IVC filter outside of guidelines in patients without prior VTE who can tolerate anticoagulation because of the low risk of developing PE.

A Population-Based Study of Inferior Vena Cava Filters in Patients With Acute Venous Thromboembolism

“…8 In a more recent single centre study, placement of IVC filters in patients with VTE approximately doubled between 2004 and 2007. 9 …”

“…Interestingly, in several studies rates of removal of temporary IVC filters have been quite low (5–20%) suggesting that most of these devices are in fact permanent. 16, 17 …”

Indications and Appropriateness of Inferior Vena Cava Filter Placement

“…These authors concluded that IVC filter placement outside of guidelines was not warranted. 18 White et al 19 did a population-based study comparing outcomes after acute VTE in 3,632 patients who had filter placement with 64,333 patients who did not receive an IVC filter. The incidence of recurrent PE at 1 year did not differ between the groups, but the incidence of rehospitalization for venous thrombosis was higher in the patients receiving an IVC filter if they initially presented with a PE.…”

Inferior Vena Cava Filters for Primary Prophylaxis: When Are They Indicated?

“…18 Singh et al found in their retrospective study of patients receiving prophylactic filters either within EAST guidelines or outside of guidelines that only the patients within guidelines derived benefit from the procedure. 19 This emphasizes the importance of defining a high-risk population that will derive benefit from prophylactic IVC filter placement.…”