The efficacy of prophylactic IVC filters in gastric bypass surgery

Wilhelm, B. Jakub; Markelov, Alexey; Sakharpe, Aniket; Baccaro, Leopoldo M.; Singhal, Vinay

doi:10.1007/s00464-014-3746-9

Cited by 9 publications

(5 citation statements)

References 28 publications

(79 reference statements)

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“…The use of inferior vena caval filters (VCFs) for prevention of PE in bariatric surgery has been evaluated in several studies, most of which were retrospective or registry studies with many differences between the VCF and non-VCF groups that likely confounded the findings. 39 Some of these studies found higher rates of DVT but similar rates of PE in the VCF groups, which might suggest a possible benefit of VCFs in preventing PE in high-risk patients. Alternatively, the higher rates of DVT might indicate that VCFs increase the risk of postoperative lower extremity venous thrombosis.…”

Section: Warfarinmentioning

confidence: 87%

Thrombosis in the setting of obesity or inflammatory bowel disease

Lentz

2016

Hematology

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Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy. Obesity alters the pharmacokinetics of some anticoagulant drugs, and IBD patients present the added management challenge of having a high risk of gastrointestinal bleeding while taking anticoagulants. An extended duration of anticoagulant therapy is often recommended for obese or IBD patients with unprovoked venous thromboembolism unless there is a high risk of bleeding, although more data and better biomarkers are needed to determine whether anticoagulation can be safely stopped in a subset of IBD patients during remission of active disease. Most patients with obesity or IBD require thromboprophylaxis in conjunction with hospitalization or surgery, with adjustment of anticoagulant dosing in patients with severe obesity.

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Section: Warfarinmentioning

confidence: 87%

Thrombosis in the setting of obesity or inflammatory bowel disease

Lentz

2016

Hematology

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“…The more recent development of a retrievable filter has encouraged the use of IVCF as these devices are easier to insert and can subsequently be removed [7,8]. Although the currently accepted clinical practice is to use IVCF only in patients with a contraindication for anticoagulation therapy [2], several studies have reported the efficacy of prophylactic IVCF in patients at high risk of VTE [3–6]. Wilhelm et al [3], published a systemic review of 8 retrospective studies on the efficacy of prophylactic IVCF insertion prior to bariatric surgery (gastric bypass) and concluded that the incidence of PE in patients without pro-phylactic IVCF was higher.…”

Section: Discussionmentioning

confidence: 99%

“…Although the currently accepted clinical practice is to use IVCF only in patients with a contraindication for anticoagulation therapy [2], several studies have reported the efficacy of prophylactic IVCF in patients at high risk of VTE [3–6]. Wilhelm et al [3], published a systemic review of 8 retrospective studies on the efficacy of prophylactic IVCF insertion prior to bariatric surgery (gastric bypass) and concluded that the incidence of PE in patients without pro-phylactic IVCF was higher. Decousus et al [6] also reported from a randomized trial that there are initial beneficial effects of prophylactic IVCF on the prevention of acute PE in high-risk patients with a proximal DVT, although there was the observed excess rate of recurrent DVT in permanent IVCF (PREPIC study).…”

Section: Discussionmentioning

confidence: 99%

“…In perioperative patients at a high risk of VTE, current guidelines recommend perioperative prophylactic anticoagulation as a preventative measure [2]. Although an inferior vena cava filter (IVCF) is currently only recommended for VTE patients showing a contraindication for anticoagulants or who develop recurrent pulmonary embolism (PE) with these drugs, several reports have suggested that this device shows prophylactic efficacy with or without anticoagulation in perioperative patients at high risk [3–6]. Thus consideration should be given to using perioperative prophylactic anticoagulation or/and IVCF in patients undergoing major surgery and with high risk factors for VTE.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of a Preoperative Inferior Vena Cava Filter in Acute Venous Thromboembolism Patients Undergoing Abdominal-Pelvic Cancer or Orthopedic Surgery

Kim

Han

et al. 2018

VSI

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PurposeSurgery is the most common risk factor for pulmonary embolism (PE) in patients with a recent venous thromboembolism (VTE). This study reviewed clinical outcomes of preoperative inferior vena cava filter (IVCF) use in patients with acute VTE during abdominal-pelvic cancer or lower extremity orthopedic surgeries.Materials and MethodsWe retrospectively analyzed 122 patients with a recent VTE who underwent IVCF replacement prior to abdominal-pelvic cancer or lower extremity orthopedic surgery conducted between January 2010 and December 2016. Demographics, clinical characteristics, postoperative IVCF status, risk factors for a captured thrombus, and clinical outcomes were collected for these subjects.ResultsAmong the 122 study patients who were diagnosed with acute VTE in the prior 3 months and underwent preoperative IVCF replacement, 70 patients (57.4%) received abdominal-pelvic cancer surgery and 52 (42.6%) underwent lower extremity orthopedic surgery. There were no perioperative complications associated with IVCF in the study population and no cases of symptomatic PE postoperatively. A captured thrombus in the filter was identified postoperatively in 16 patients (13.1%). Logistic regression analysis indicated that postoperative anticoagulation within 48 hours significantly reduced the risk of a captured thrombus (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08–0.94; P=0.032).ConclusionA captured thrombus in preoperative IVCF was identified postoperatively in 16 patients (13.1%). Postoperative anticoagulation within 48 hours reduces the risk of captured thrombus in these cases.

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“…5 The combination of newer generation retrievable filters and ease of insertion has led to a huge increase in the use of IVC filters, and currently an estimated one in eight patients with documented venous thromboembolism (VTE) receives an IVC filter as part of early treatment, 6 while an additional 20% of all IVC filters are placed prophylactically in patients without VTE, such as preoperatively or in the setting of trauma. 7,8 Accompanying this increase in insertion is a concern about the lack of retrieval and the subsequent possibility for the complications of long-term implantation such as DVT, filter fracture, filter migration, and caval occlusion.…”

mentioning

confidence: 99%

Inferior Vena Cava Filters: When to Place and When to Remove

Moriarty

Steinberger

2017

Semin Respir Crit Care Med

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Pulmonary embolism (PE) is a common and feared result of deep vein thrombosis. While anticoagulation is the mainstay of management, interruption of flow of thrombus from leg veins to the pulmonary circulation is frequently desired either in lieu of or in addition to anticoagulation. Inferior vena cava filters have become frequently used to prevent PE despite a paucity of evidence for efficacy and increasing concerns about the long-term complications of indwelling filters.

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The efficacy of prophylactic IVC filters in gastric bypass surgery

Cited by 9 publications

References 28 publications

Thrombosis in the setting of obesity or inflammatory bowel disease

Thrombosis in the setting of obesity or inflammatory bowel disease

Clinical Outcomes of a Preoperative Inferior Vena Cava Filter in Acute Venous Thromboembolism Patients Undergoing Abdominal-Pelvic Cancer or Orthopedic Surgery

Inferior Vena Cava Filters: When to Place and When to Remove

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