Inferior vena cava filters

Abstract

To cite this article: Duffett L, Carrier M. Inferior vena cava filters. J Thromb Haemost 2017; 15: 3-12.Summary. Use of inferior vena cava (IVC) filters has increased dramatically in recent decades, despite a lack of evidence that their use has impacted venous thromboembolism (VTE)-related mortality. This increased use appears to be primarily driven by the insertion of retrievable filters for prophylactic indications. A growing body of evidence, however, suggests that IVC filters are frequently associated with clinically important adverse events, prompting a closer look at their role. We sought to narratively review the current evidence on the efficacy and safety of IVC filter placements. Inferior vena cava filters remain the only treatment option for patients with an acute (within 2-4 weeks) proximal deep vein thrombosis (DVT) or pulmonary embolism and an absolute contraindication to anticoagulation. In such patients, anticoagulation should be resumed and IVC filters removed as soon as the contraindication has passed. For all other indications, there is insufficient evidence to support the use of IVC filters and high-quality trials are required. In patients where an IVC filter remains, regular follow-up to reassess removal and screen for filter-related complications should occur.

Isolated Clot, Real Error

“…Since the 1990s, the use of IVC filters has increased markedly, despite limited evidence of their efficacy. To date, the only universal recommendation for IVC filters is for acute treatment of proximal DVT or PE in patients with absolute contraindications to anticoagulation . Randomized trials assessing outcomes of IVC filter placement that only included patients who also were treated with anticoagulants did not find a clear benefit .…”

Anticoagulación en enfermedad tromboembólica venosa

“…En el caso de recurrencia del TEP en manejo con anticoagulación a dosis plena, así como en caso de contraindicación para ésta (sangrado incontrolable activo, riesgo de sangrado que amenace la vida o cirugía de urgencia que requiere detener anticoagulación), tiene indicación el filtro de vena cava inferior, que idealmente debe ser retirado una vez desaparezca la contraindicación para anticoagulación 9 . En pacientes con TVP y cáncer ha mostrado disminución de la recurrencia al utilizar los filtros asociado a terapia anticoagulante, pero sin impactar en la mortalidad 10 . La terapia anticoagulante marcó un hito en el manejo de la ETV impactando enormemente en la mortalidad que antes era de 30% sin tratamiento.…”

Effect of Inferior Vena Cava Filter on Venous Thromboembolism Mortality in Japan ― JROAD and JROAD-DPC Registry Analysis ―

“…The prognostic difference of these IVCF types is unknown so far. 4 The permanent type may lead to DVT recurrence, and the retrievable type may be related with device retrieval-related complications. 4 Further precise analysis focused on IVCF type is required.…”

“…4 The permanent type may lead to DVT recurrence, and the retrievable type may be related with device retrieval-related complications. 4 Further precise analysis focused on IVCF type is required. With regard to statistical limitations, type I error might have been inflated due to multiple tests.…”

“…3 Inferior vena cava filters (IVCF) trap venous emboli from the lower extremities and prevent clinically significant PE. 4 More patients in Japan than in other countries have IVCF, including those who are being treated with standard anticoagulation. 5 The Japan VTE Treatment Registry (JAVA) has found that 40% of patients with VTE have an IVCF.…”