From the Guidelines
Inferior Vena Cava (IVC) filters are indicated in patients with acute pulmonary embolism (PE) or deep vein thrombosis (DVT) who have absolute contraindications to anticoagulation or those who have failed anticoagulation therapy 1.
Key Indications
- Patients with contraindications to anticoagulation, such as active bleeding or a high risk of bleeding 1
- Patients with recurrent PE despite adequate anticoagulation, defined as a minimum of 3 months of therapeutic anticoagulation with a vitamin K antagonist or a direct oral anticoagulant (DOAC) 1
- Patients with severe cardiorespiratory compromise 1
Additional Considerations
- Temporary IVC filters may be preferred in patients with a time-limited indication for an IVC filter, such as those with a short-term contraindication to anticoagulation therapy 1
- Permanent IVC filters may be considered in patients who will require long-term IVC filtration, such as those with a long-term contraindication to anticoagulation 1
- Anticoagulant treatment should be resumed in patients with an IVC filter once contraindications to anticoagulation or active bleeding complications have resolved 1
From the Research
Indications for Inferior Vena Cava (IVC) Filters
The indications for IVC filters include:
- Patients with acute venous thromboembolism (VTE) who have a contraindication to anticoagulation 2, 3, 4
- Patients with recurrent VTE despite anticoagulation therapy 2, 5, 4
- Patients at high risk of VTE who cannot tolerate anticoagulation 3, 6
- Cancer patients with DVT or PE who have contraindications to anticoagulation therapy 4
- Hemodynamically unstable patients with acute pulmonary embolism (PE) who have absolute contraindications to anticoagulant drugs and/or recurrent PE despite treated with an adequate anticoagulant regimen 5
Contraindications to Anticoagulation
Contraindications to anticoagulation that may indicate the use of an IVC filter include:
- Perioperative patients 4
- CNS metastases 4
- Thrombocytopenia 4
- Bleeding 4
- Other conditions that increase the risk of bleeding 4
High-Risk Patients
High-risk patients who may benefit from an IVC filter include:
- Patients with extensive disease burden 6
- Patients who must have anticoagulation held during surgery 6
- Patients with primary prevention in high-risk patients 6
Important Considerations
It is essential to note that the use of IVC filters should be guided by clinical guidelines and that the benefits and risks of filter placement should be carefully weighed on a case-by-case basis 2, 5, 3, 4, 6. Additionally, follow-up is crucial to detect IVC filter-related complications and to increase retrieval rate 3, 6.