Guidelines for the Use of Optional Retrievable Vena Cava Filters

Guidelines for the Use of Optional Retrievable Vena Cava Filters

John Kaufman
European Respiratory Disease 2007 - Issue I
Published: October 2008
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Retrievable inferior vena cava (IVC) filters are being utilised with increasing frequency. The availability of retrievable IVC filters is widely believed to contribute to the progressive relaxation of the indications for filter placement. These events are occurring in the absence of prospective randomised trials confirming the benefit of removal of vena cava filters. In response to this lack of information, the Society of Interventional Radiology (SIR) convened a multidisciplinary consensus conference to develop guidelines for the use of retrievable filters on 14 and 15 January 2005.

Representatives from interventional radiology, trauma surgery, vascular surgery and internal medicine participated (Appendix 1). The goal of the consensus conference was to produce a document of guidelines for all physicians using retrievable vena cava filters. The discussion focused on optional filters (retrievable or convertible) as a general class of devices, not on individual filters. The consensus panel addressed the indications for placement of optional filters and recommended follow-up while filters are in place, the evaluation of patients before discontinuation of filtration and management of patients after the procedure. The document was first published in March 2006.1

Why Optional Filters?
The current first-line treatment and prevention of venous thromboembolism (VTE) is anticoagulation.2 When a patient is considered at high risk of pulmonary embolism (PE) and anticoagulants are contraindicated or have failed, an IVC filter is generally placed. Filters do not treat established PE or deep vein thrombosis (DVT), nor do they prevent the development of de novo VTE. Permanent vena cava filters are strongly believed to increase the long-term risk of DVT without reducing the overall mortality from VTE.3,4 The role of permanent filters in patients with VTE remains an area of some controversy.2,5,6

The risk factors for VTE are numerous and some, such as trauma or surgery, are transient.7 In a similar manner, contraindications to anticoagulation in patients with or at risk of VTE may be temporary. It seems reasonable that patients transiently at high risk for clinically significant PE and with transient contraindications to anticoagulation may not require permanent caval interruption. Although data are lacking, the use of optional devices is in part driven by concern over complications of permanent filters.8

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References:
  1. Kaufman J, Kinney T, Streiff M, et al., Guidelines for the use of retrievable and convertible vena cava filters: report from the society of interventional radiology multidisciplinary consensus conference, J Vasc Interv Radiol, 2006;17:449–59.
  2. Buller H, Agnelli G, Hull R, et al., Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest, 2004;126: 401S–428S.
  3. Investigators P, Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study, Circulation, 2005;112: 416–22.
  4. White R, Zhou H, Kim J, Romano P, A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism, Arch Intern Med, 2000;160:2033–41.
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  8. Stein P, Kayali F, Olson R, Twenty-one-year trends in the use of inferior vena cava filters, Arch Intern Med, 2004;164:1541–5.
  9. Kinney T, Update on inferior vena cava filters, J Vasc Interv Radiol, 2003;14:425–40.
  10. Karmy-Jones R, Jurkovich GJ, Velmahos GC, et al., Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study, J Trauma, 2007);62: 17–24.
  11. Ansell J, Hirsh J, Poller L, et al., The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest, 2004;126:204S–233S.
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  13. Hirsh J, Raschke R, Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest, 2004;126:188S–203S.
  14. Gerotziafas G, Samama M, Prophylaxis of venous thromboembolism in medical patients, Curr Opin Pulm Med, 2004;10:356–65.
  15. Carson J, Kelley M, Duff A, et al., The clinical course of pulmonary embolism, N Engl J Med, 1992;326:1240–45.
  16. Decousus H, Leizorovicz A, Parent F, et al., A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group, N Engl J Med, 1998;338:409–15.
  17. Douketis J, Foster G, Crowther M, et al., Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy, Arch Intern Med, 2000;160:3431–6.

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