Inferior vena cava filters in cancer patients: to filter or not to filter

Abstract

Purpose:Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE); active cancer accounts for almost 20% of all newly diagnosed VTE. Inferior vena cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation in high-risk situations. In this report, and utilizing a case study, we will address the appropriate utilization of such filters in cancer patients.Methods:The case of a 43-year-old female patient with rectal cancer, who developed deep vein thrombosis following a complicated medical course, will be presented. The patient was anticoagulated with a low molecular weight heparin, but a few months later and following an episode of bleeding, an IVC filter was planned. Using the PubMed database, articles published in English language addressing issues related to IVC filters in cancer patients were accessed and will be presented.Results:Many recent studies questioned the need to insert IVC filters in advanced-stage cancer patients, particularly those whose anticipated survival is short and prevention of PE may be of little clinical benefit and could be a poor utilization of resources.Conclusion:Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or pulmonary embolism is high, IVC filters can be utilized. However, placement of such filters should take into consideration the stage of disease and life expectancy of such patients.

Analysis of risk factors for recurrence of deep venous thrombosis in lower extremities

“…The frequency of IVCF implantation has increased over time from 10%–32% in the early years [ 25 – 27 ]. It has been revealed that indications for IVCF implantation are strictly applied in only 51% of patients receiving IVCF implantation and 26% patients are actually not suitable for IVCF implantation [ 28 ]. There is evidence showing that implantation of IVCF has no influence on the PE-related mortality and total mortality, and 7–38% of patients receiving IVCF implantation develop DVT.…”

Cancer-Associated Thrombosis: An Overview

“…Abdel-Razeq et al revealed that the IVC filter should be considered for patients who are currently bleeding or are at high risk for bleeding, patients who have recurrent VTE despite anticoagulation or develop VTE immediately postoperatively, and patients who present with a large primary or metastatic CNS tumor or present with cor pulmonale. 62 treatment of incidental Vte. Incidental or unsuspected VTE is defined as evidence of thrombosis detected on imaging studies performed for other indications such as cancer staging.…”

Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

“…While some studies suggested that IVCFs are safe and effective, others found an increased risk of recurrent deep venous thrombosis (DVT; indeed, the cancer-related hypercoagulability is not corrected by the IVCF), as well as no benefit regarding pulmonary embolism (PE) incidence or short-term mortality. [34][35][36][37][38][39][40] Nevertheless, most guidelines recommend the use of IVCF in cancer patients with proximal acute DVT or PE when anticoagulant therapy is contraindicated. [41][42][43][44] Such is the case of major surgery or invasive procedures.…”

“…• Results from studies on the use of IVCF in cancer patients with VTE are controversial. [34][35][36][37][38][39][40] • Consensus exists on its use in patients with PE or DVT when ACG is contraindicated, especially in the first weeks after VTE. [41][42][43][44] • Concern about early and delayed adverse effects associated with IVCF is increasingly growing.…”