Inferior vena cava filters: a framework for evidence-based use

Kelkar, Amar H.; Rajasekhar, Anita

doi:10.1182/hematology.2020000149

Cited by 34 publications

(21 citation statements)

References 50 publications

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“…IVC filter placement can also mitigate some risk; however, placement is not without risk 37–43. As such, this is a controversial topic that needs further investigation in this population as treatment options vary widely in the literature 44–49. The granularity of our data presented a unique opportunity to demonstrate that patients receiving lower doses of anticoagulation/antiplatelet medications had an overall higher incidence of VTE events, all while not having any major bleeding complications in the fully anticoagulated cohort.…”

Section: Discussionmentioning

confidence: 82%

What happens after they survive? The role of anticoagulants and antiplatelets in IVC injuries

Hynes

Scantling

Murali

et al. 2022

Trauma Surg Acute Care Open

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BackgroundVenous thromboembolism (VTE) after an inferior vena cava (IVC) injury is a devastating complication. Current practice involves variable use of anticoagulation and antiplatelet (AC/AP) agents. We hypothesized that AC/AP can reduce the incidence of VTE and that delayed institution of AC/AP is associated with increased VTE events.MethodsWe retrospectively reviewed IVC injuries cared for at a large urban adult academic level 1 trauma center between January 1, 2008 and December 31, 2020, surviving 72 hours. Patient demographics, injury mechanism, surgical repair, type and timing of AC, and type and timing of VTE events were characterized. Postoperative AC status during hospital course before an acute VTE event was delineated by grouping patients into four categories: full, prophylactic, prophylactic with concomitant AP, and none. The primary outcome was the incidence of an acute VTE event. IVC ligation was excluded from analysis.ResultsOf the 76 patients sustaining an IVC injury, 26 were included. The incidence of a new deep vein thrombosis distal to the IVC injury and a new pulmonary embolism was 31% and 15%, respectively. The median onset of VTE was 5 days (IQR 1–11). Four received full AC, 10 received prophylactic AC with concomitant AP, 8 received prophylactic AC, and 4 received no AC/AP. New VTE events occurred in 0.0% of full, in 30.0% of prophylactic with concomitant AP, in 50.0% of prophylactic, and in 50.0% without AC/AP. There was no difference in baseline demographics, injury mechanisms, surgical interventions, and bleeding complications.DiscussionThis is the first study to suggest that delay and degree of antithrombotic initiation in an IVC-injured patient may be associated with an increase in VTE events. Consideration of therapy initiation should be performed on hemostatic stabilization. Future studies are necessary to characterize the optimal dosing and temporal timing of these therapies.Level of evidenceTherapeutic, level 3.

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Section: Discussionmentioning

confidence: 82%

What happens after they survive? The role of anticoagulants and antiplatelets in IVC injuries

Hynes

Scantling

Murali

et al. 2022

Trauma Surg Acute Care Open

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“…16,17 Inferior vena cava (IVC) filters should be reserved for patients with acute PE who have contraindications to anticoagulation. 18 Under particular and challenging circumstances, such as in those with a history of multiple recurrent VTE despite being adequately anticoagulated, IVC filters may also be considered. 18 PERTs may be helpful in deciding which patients may benefit from advanced therapies by balancing the paucity of robust studies with technological advancements with multiple endovascular devices that could potentially be useful in appropriately selected patients.…”

Section: S Truc Ture Fun C Tion and R Ati Onale For Pertsmentioning

confidence: 99%

“…18 Under particular and challenging circumstances, such as in those with a history of multiple recurrent VTE despite being adequately anticoagulated, IVC filters may also be considered. 18 PERTs may be helpful in deciding which patients may benefit from advanced therapies by balancing the paucity of robust studies with technological advancements with multiple endovascular devices that could potentially be useful in appropriately selected patients. Figure 2 illustrates PERT indicators for activation and guides potential therapeutic options for patients with acute complex PE.…”

Section: S Truc Ture Fun C Tion and R Ati Onale For Pertsmentioning

confidence: 99%

“…Inferior vena cava (IVC) filters should be reserved for patients with acute PE who have contraindications to anticoagulation 18 . Under particular and challenging circumstances, such as in those with a history of multiple recurrent VTE despite being adequately anticoagulated, IVC filters may also be considered 18 .…”

Section: Therapeutic Tools Available For Pertsmentioning

confidence: 99%

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Pulmonary embolism response teams: Changing the paradigm in the care for acute pulmonary embolism

Porres‐Aguilar

Rosovsky

Rivera‐Lebron

et al. 2022

Journal of Thrombosis and Haemostasis

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Pulmonary embolism response teams (PERTs) have emerged as a multidisciplinary, multispecialty team of experts in the care of highly complex symptomatic acute pulmonary embolism (PE), with a centralized unique activation process, providing rapid multimodality assessment and risk stratification, formulating the best individualized diagnostic and therapeutic approach, streamlining the care in challenging clinical case scenarios (e.g., intermediate–high risk and high‐risk PE), and facilitating the implementation of the recommended therapeutic strategies on time. PERTs are currently changing how complex acute PE cases are approached. The structure, organization, and function of a given PERT may vary from hospital to hospital, depending on local expertise, specific resources, and infrastructure for a given academic hospital center. Current emerging data demonstrate the value of PERTs in improving time to PE diagnosis; shorter time to initiation of anticoagulation reducing hospital length of stay; increasing use of advanced therapies without an increase in bleeding; and in some reports, decreasing mortality. Importantly, PERTs are positively impacting outcomes by changing the paradigm of care for acute PE through global adoption by the health‐care community.

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“…2 Inferior vena cava filtration is most likely to benefit patients at high risk (presence of caval thrombus or free-floating thrombus image during venography) of iatrogenic pulmonary embolism during endovenous intervention. 3,4 Finally, it is mentioned that five patients have current cancer diagnosis. Have the life expectancy of these patients been taken into consideration while planning the intervention?…”

mentioning

confidence: 99%