Inferior vena cava filters in pulmonary embolism: A historic controversy

Abstract

Objective: Rationale for non-routine use of inferior venous cava filters (IVCF) in pulmonary embolism (PE) patients. Methods: Thrombosis mechanisms involved with IVCF placement and removal, the bloodcontacting medical device inducing clotting, and the inorganic polyphosphate in the contact activation pathway were analyzed. In addition, we analyzed clinical evidence from randomized trials, including patients with and without cancer. Furthermore, we estimated the absolute risk reduction (ARR), the relative risk reduction (RRR), and the number needed to treat (NNT) based on the results of each study using a frequency table. Finally, we analyzed the outcome of our PE patients that were submitted to thrombolysis with short and long term follow-up. Results: IVCF induces thrombosis by several mechanisms including placement and removal, rapid protein adsorption, and simultaneous surface-induced activation via the contact activation pathway. Also, inorganic polyphosphate has an important role as a procoagulant, reversing the effect of anticoagulants. Randomized control trials included 904 cancer and non-cancer PE patients. In terms of ARR, RRR, and NNT, there is no evidence for routine use of IVCF. In 290 patients with proved PE, extensive thrombotic burden and right ventricular dysfunction under thrombolysis and oral anticoagulation, we observed a favorable outcome in a short-and long-term follow-up; additionally, IVCF was only used in 5% of these patients.

Clinical Observation of Uninterrupted Thrombolytic Therapy via Indwelling Catheter for Lower Limb Deep Vein Thrombosis

“… 25 IVCF implantation can not only prevent a fatal pulmonary embolism, but also provides a safety guarantee for interventional catheter thrombolytic therapy. 26 We believe that after thrombolysis, the stenosis of the deep vein lumen is more than 50%, and balloon dilation combined with stent implantation should be done with caution. The stent itself can cause damage to the inner wall of the blood vessel, produce an inflammatory reaction, or cause endothelial hyperplasia.…”

The Hospital Zambrano Hellion venous thromboembolism rapid response team (PREVENTION-team): Improving pulmonary embolism and deep venous thrombosis patient care

“…This approach has shown to be effective with a lower dose of the thrombolytic drug and shorter procedural time with no difference in major bleeding or recurrence 33 . As part of the thrombectomy procedure, we recommend the use of a prophylactic vena cava filter, as 17% of patients treated suffered asymptomatic PE demonstrated on computed tomography scans 34 . These filters should be removed as soon as possible 35 .…”

“…International and national guidelines 26,[27][28][29][30][31][32][33][34][35][36][37][38] recommend unfractionated heparin as adjunctive treatment and systemic thrombolysis in a well-selected (Table 5) 11 39 . The PEITHO study 40 and additional previous evidence have shown in-hospital improvement outcome, with systemic thrombolysis 14,16,17,19 in this group.…”

Equipo de respuesta rápida para tromboembolismo venoso del Hospital Zambrano Hellion (PREVENTION -Team): Mejorando el manejo del tromboembolismo pulmonar y trombosis venosa profunda

“…International and national guidelines 26,[27][28][29][30][31][32][33][34][35][36][37][38] recommend unfractionated heparin as adjunctive treatment and systemic thrombolysis in a well-selected (Table 5) 11 39 . The PEITHO study 40 and additional previous evidence have shown in-hospital improvement outcome, with systemic thrombolysis 14,16,17,19 in this group.…”