Friday, July 18, 2014

Update on vena caval filters

Here's a recent review.

The review covers both SVC and IVC filters.

SVC filters

Upper extremity DVT has a relatively low risk of causing PE. Moreover a significant complication rate associated with SVC filters raises the question of whether the benefits exceed the risks. From the review:

The low rate of PE and fatal PE associated with upper extremity thrombosis and the morbidity and mortality associated with SVC filters indicate that filters should not be used for upper extremity thrombosis except in the most extreme of circumstances.

IVC filters

Clinical judgment may occasionally dictate the use of an IVC filter in patients with high risk, large clot burden PEs who also have acute DVT. Low level evidence suggests that this approach may be beneficial. However, support for IVC filters based on high quality evidence is limited and at present the only well established indication is for acute proximal DVT and a contraindication to anticoagulant therapy. Here is a summary from the review:

Practice points
Vena cava filters prevent pulmonary embolism.

Vena cava filters increase the risk for deep venous thrombosis and vena cava thrombosis.

The only guideline approved indication for vena cava filter placement is prevention of pulmonary embolism in patients with known DVT and contraindication to anticoagulation.

Optional vena cava filters are preferred for most patients unless they have a permanent contraindication to anticoagulation and their risk for thromboembolism is persistent.

Optional vena cava filters should be removed whenever they are no longer indicated. Physicians and hospitals need to implement programs to follow patients with optional filters in order to optimize filter retrieval rates.

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