From the Guidelines
The use of IVC filters is conditionally recommended against in patients who can be safely treated with anticoagulant therapy, due to the low certainty in the evidence of their effects, as stated in the 2020 American Society of Hematology guidelines 1. When considering the use of IVC filters, it is essential to weigh the potential benefits against the risks, including the risk of recurrent deep vein thrombosis (DVT) and the development of post-thrombotic syndrome. The decision to use an IVC filter should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history. Some key points to consider include:
- The patient's ability to safely receive anticoagulant therapy
- The presence of significant preexisting cardiopulmonary disease or hemodynamic compromise related to preexisting pulmonary embolism (PE)
- The potential benefits and risks of IVC filter placement, including the risk of filter occlusion and recurrent DVT
- The availability of retrievable filters, which can be removed once the patient is able to be safely treated with anticoagulant therapy, as recommended by the American Society of Hematology guidelines 1. It is also important to note that the use of IVC filters is not recommended for routine use in patients with venous thromboembolism (VTE), but rather for specific situations where the benefits outweigh the risks, such as in patients with contraindications to anticoagulation or those at high risk of recurrent VTE, as discussed in the European Society of Cardiology guidelines 1 and the American College of Radiology Appropriateness Criteria 1. Overall, the use of IVC filters should be approached with caution and carefully considered on a case-by-case basis, with a focus on minimizing risks and maximizing benefits for the patient.
From the Research
IVC Filter Overview
- IVC filters are used to prevent pulmonary embolism (PE) in patients who are at risk of thrombo-embolic disease 2
- The use of IVC filters has increased over the years, and they are often seen on routine abdominal CT scans 3
Complications of IVC Filters
- IVC filters are associated with increased risk of IVC thrombosis and lower-extremity deep venous thrombosis (DVT) as compared to anticoagulation alone 2
- Complications related to IVC filters include thrombosis, filter migration and penetration, and problems associated with filter deployment 3
- IVC filter thrombosis is a main long-term complication of IVC filter placement, and certain double-basket filter designs and hypercoagulable states are associated with increased incidence of IVC filter thrombosis 4
Management of IVC Filter Thrombosis
- Anticoagulation remains the standard of care for IVC filter thrombosis, but endovascular techniques to restore IVC patency have become key adjunctive therapies in recent years 5
- Treatment options for IVC filter thrombosis include expectant management with anticoagulation, catheter-directed thrombolysis (CDT), mechanical thrombectomy, stenting, or a combination 5
- Technical success, defined as restoration of IVC patency, can be achieved in most properly selected patients who undergo intervention for IVC filter thrombosis 5
Factors to Consider Regarding the Need for IVC Filters
- There continues to be controversy on the use of IVC filters in patients with deep venous thrombosis, pulmonary embolism, and venous thromboembolism 6
- Guidelines are suggested regarding the patients who need and who do not need IVC filters, based on the current state of knowledge regarding the efficacy and risks of this therapy 6