Inferior vena cava filters (IVCFs): a review of uses and application to international guidelines at a single Australian center; implications of venous thromboembolism associated with malignancy

Abstract

Venous thromboembolism (VTE) is a potentially lethal event. Anticoagulation is the cornerstone of treatment. Inferior vena cava filters (IVCFs) may be used in circumstances when anticoagulation is contraindicated or as an adjunct to anticoagulation. IVCF use is not without controversy due to concerns over their safety profile, differences in guidelines from international societies, and a limited randomized control trial evidence. We retrospectively undertook a review of IVCF use over a three-year period (2014–2016) at our center, which has a large oncology service but no trauma unit. There were 44 patients with successful IVCF insertion and one patient with an unsuccessful attempt. Indications for insertion included: a contraindication to anticoagulation (n = 28); recurrent VTE on anticoagulation (n = 10); and extensive VTE (n = 7). There were 13 retrieval attempts, of which ten were successful. There were five documented IVCF complications (tilting: n = 2, IVC thrombus: n = 3) with one episode of IVCF failure and two episodes of deep vein thrombosis during the follow-up period. Of the patients, 71% had an active malignancy (of whom 71% had metastatic disease). Seventeen patients died due to progressive malignancy during the study period. There were no life-threatening VTEs or IVCF-associated mortalities. Adherence with published international guidelines was variable. Patients with malignancy were less likely to undergo IVCF retrieval and had a reduced rate of retrieval success. None of the international guidelines comment on the use of IVCFs in patients with malignancy despite being commonly used. IVCF use may be an underappreciated tool in this group.

Dilemmas in anticoagulation and use of inferior vena cava filters in venous thromboembolism; a survey of Respiratory Physicians, Haematologists and Medical Oncologists and a review of the literature

“…The British Committee for Standards in Haematology (BCSH) guidelines recommend considering IVCF use in patients scheduled for surgery with recent VTE (< 1 month) in whom anticoagulation must be interrupted [5]. This is consistent with previously published experience at our centre [19]. In this setting there is a relative indication for IVCF use.…”

“…We have previously published our experience with IVCF use at our centre where we found a preponderance of use outside established guidelines. 19 This drove our interest in understanding how Australian specialists approached common clinical dilemmas around IVCF use in VTE.…”

Retroperitoneal extragonadal seminoma developed with acute lower inferior vena cava syndrome: A case report

“…Accepted indications for IVC filters are in patients with acute venous thromboembolism and absolute contraindications to anticoagulation or in patients who have failed adequate anticoagulation. 5 The increased use of IVC filters is not supported by high-quality evidence, and none of the international guidelines comment on the use of IVC filters in patients with malignancy despite being commonly used; however, the present case was treated with anticoagulation therapy and IVC filter insertion because of the pulmonary embolism with dyspnea and the massive residual leg thrombus. Patients with malignancy were said to be less likely to undergo IVC filters retrieval and had a reduced rate of retrieval success.…”

“… 3 The endovascular approach with stent placement for IVC obstruction is the treatment modality of choice for chronic IVC obstruction; however, reports on the interventional treatment of malignant inferior vena cava obstructions are rare. 5 In the present case, the chief complaints were rapidly progressive leg edema and pain due to the IVC obstruction and thrombus, therefore, we didn't select an endovascular approach for the first time. Venous thromboembolism is a potentially lethal event.…”

“…Patients with malignancy were said to be less likely to undergo IVC filters retrieval and had a reduced rate of retrieval success. 5 The patient has also kept under surveillance without removing the IVC filter.…”