When is ivc filter indicated

There are no randomized studies to compare the efficacy of permanent IVC filters and retrievable filters for PE prevention. In addition, the frequency of symptomatic IVC thrombosis was similar 1. Due to the long-term complications of permanent IVC filters, it is suggested that a retrievable IVC filter be used for patients with temporary contraindications to anticoagulation. If the duration of contraindication to anticoagulation is short or uncertain, a retrievable filter is recommended.

There are no randomized controlled trials to guide the use of concomitant anticoagulation after filter insertion, although this intervention may be beneficial to prevent DVT propagation, recurrence, or IVC filter thrombosis.

The duration and degree of anticoagulation was not presented in all of the studies in the meta-analysis, therefore limiting the analysis. In addition to the ACCP guidelines, there have been other proposed indications for IVC filter use, including recurrent VTE despite anticoagulation, chronic recurrent PE with pulmonary hypertension, extensive free-floating iliofemoral thrombus, and thrombolysis of ilio-caval thrombus.

Our patient developed a significant complication from anticoagulation. The anticoagulation was discontinued and a retrievable IVC filter was placed.

Once a patient no longer has a contraindication for anticoagulation, the ACCP recommends restarting a conventional course of anticoagulation. Thus, once the patient can tolerate anticoagulation, consideration will be given to removal of the retrievable filter. Other indications for IVC filter use are not supported by the current literature.

Kantsiper is a hospitalist and assistant professor at Bayview Medical Center. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism.

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Twenty-one-year trends in the use of inferior vena cava filters. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Smouse B, Johar A. Is market growth of vena cava filters justified? Endovasc Today. February ; Google Scholar. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference.

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Retrospective review of Celect inferior vena cava filter retrievals: experience at a single institution. Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. Food and Drug Administration. Removing retrievable inferior vena cava filters: initial communication. August 9, Accessed February 10, Outcomes with retrievable inferior vena cava filters: a multicenter study.

Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. Improving inferior vena cava filter retrieval rates: impact of a dedicated inferior vena cava filter clinic. Accessed November 29, Institutional protocol improves retrievable inferior vena cava filter recovery rate. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. Accessed February 6, The Inferior Vena Cava Filter.

White et al compared the frequency of vena cava filter VCF use for venous thromboembolism VTE among California hospitals in a 5-year retrospective observational study. A Viewpoint by Prasad et al follows. Richard H.

Save Preferences. Privacy Policy Terms of Use. This Issue. Views 45, Citations View Metrics. Twitter Facebook More LinkedIn. Original Investigation. April 8, Mark Sloan, MD. Editor's Note. Filter placement. Indications for filter placement. Venous thromboembolism. Follow-up data. Selected complications. Back to top Article Information. Access your subscriptions. Access through your institution. Add or change institution.

Free access to newly published articles. Purchase access. Rent article Rent this article from DeepDyve. Access to free article PDF downloads. Better understanding of the effect of IVCF in this population would require patient-level data.

Also, as noted above, PREPIC 2 attempted to offer information regarding high-risk patients; however, researchers' definition of high-risk was not necessarily the same as that used in clinical practice.

Other indications can only be supported by lower, often anecdotal, quality data. Mobile "free floating" proximal thrombus and "large clot burden" such as ilio-femoral DVT are such indications with the intent of preventing hemodynamic decompensation from embolization. Prophylactic IVCF use is perhaps the most contentious application of these devices.

Several patient categories have been advocated for this indication. These include patients undergoing bariatric surgery, 20 multi-trauma patients, and patients with spinal cord injury. Nonetheless, many believe this practice should be limited as microemboli will not be trapped by the filter and as the lytic agent and anticoagulation used during the procedure will also prevent major adverse embolic events. Other than appropriate patient selection, perhaps equally important are appropriate surveillance and retrieval.

Furthermore, in the current era of accountability, it is important for both providers and payers to be able to measure appropriate use. While in most prominent centers in the United States this is still performed manually if at all , 28,30 computerized surveillance systems may show promise.

In our institution we have implemented such a system that follows IVCF insertion and retrieval. While not all IVCF are retrieved, some remain permanent purposefully after thoughtful deliberation. Other appropriate reasons for non-retrieval such as patient refusal or patient demise are now being documented. In conclusion, IVCF are likely being over-utilized.

Retrieval rates are low and information regarding appropriate use and surveillance are lacking. Use of these devices should be limited to patients with acute VTE who cannot receive anticoagulation. When IVCF are inserted for other indications this should be after much thought and coupled with appropriate documentation.

Implementation of system wide mechanisms to ensure appropriate IVCF use, surveillance and retrieval is crucial in order to prevent important clinically relevant complications. Effect of delayed inferior vena cava filter retrieval after early initiation of anticoagulation.

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