Inferior vena cava filters in patients with advanced-stage cancer

Abstract

Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or PE is high, IVC filters can be utilized. However, the placement of such filters should take into consideration the stage of disease and life expectancy of such patients. Patients with advanced-stage disease may gain little benefit from IVC filter insertion.

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.…”

The Role of Inferior Vena Cava Filters in Cancer Patients

“…To date, the majority of available data on IVCF use in cancer patients are on permanent IVCF (pIVCF) use in patients with advanced disease, 43 where they can be placed without greater rates of complication in cancer patients. 44 Moreover, pIVCF are effective at preventing VTE in this setting 45,46 However, IVCF use has failed to demonstrate a survival benefit in individuals with stage IV disease, [47][48][49] except for in those with preserved performance status. 50 Furthermore, IVCF may negatively impact quality of life in certain populations; for example, IVCF placement in patients with intracranial malignancies has been associated with filter/IVC thrombosis, post-phlebitic syndrome, and recurrent deep vein thrombosis (DVT).…”

Inferior Vena Cava Filters: Indications, Outcomes, and Evidence

“…A retrospective, single-center study analyzed the outcomes of patients with advanced cancer and IVCF placement for VTE [54]. Of the patients analyzed, 96.2 % had a contraindication to or complication from anticoagulation, 94.2 % had tumor, node, and metastasis (TNM) stage III or IV disease, 30.8 % were receiving hospice or palliative care and 16.8 % were Bdo not resuscitate.^There was an incidence of 9.3 % recurrent DVT and 2.8 % recurrent PE.…”