Clinical review: Inferior vena cava filters in the age of patient-centered outcomes

Figures & data

Figure 1. Permanent IVC filters. (A) Cordis TrapEase. (B) Boston Scientific Greenfield. (C) Braun Venatech LP.

Figure 2. Retrievable IVC filters. (A) Rex Medical Option. (B) Cook Gunther Tulip. (C) Cook Celect. (D) Bard G2x.

Table I. Prospective randomized trials on inferior vena cava filters (5–8).

Study	n	Population	Study intervention	Control	Outcomes
					Pulmonary embolism	Mortality	Deep vein thrombosis
FIT study, 2011^a	34	High-risk trauma patients	IVCF	No IVCF	0.0% (n = 0) IVCF group versus 3% (n = 1) in the no IVCF group^b	3% (n = 1) in the IVCF group^c versus 0% (n = 0) in the no IVCF group^b	3% (n = 1) in the IVCF group versus 0% (n = 0) in the no IVCF group^b
			Both groups received chemoprophylaxis when deemed appropriate
PREPIC 1999/2005	400	High risk for PE	IVCF (n=200)	No IVCF (n = 200)	1.1% IVCF versus 4.8% control (P = 0.03)^d No difference at 2 years^e 6.2% IVCF versus 15.1% control (P = 0.008)^f (symptomatic PE) at 8 years	No difference^d No difference^e No difference^f	NA^d 20.8% IVCF versus 11.6% no IVCF (P = 0.02)^e 35.7% IVCF versus 27.5% no IVCF (P = 0.042)^f
			Both groups received chemoprophylaxis
Fullen, 1973	129	Femoral fracture	IVCF (n = 41)^g	No IVCF (n = 59)^g	4% IVCF	10% deaths (IVCF)	No difference in phlebitis
			Both groups did not receive chemoprophylaxis		32% control (P = not performed)	24% (control)

IVCF = inferior vena cava filter; PREPIC = Prevention du Risqué d’Embolie Pulmonaire par Interruption Cave.

^aDesigned primarily as a feasibility study.

^bSecondary outcome, not primary purpose of study.

^cNot VTE-related.

^d12 days after randomization.

^e2 years after randomization.

^f8 years after randomization.

^g29 patients excluded (22 refused IVCF and 7 technically unable to insert).

Table II. Comparison of recommendations for IVCF between the 2008 and 2012 ACCP guidelines and the current ACR–SIR guidelines (44–48).

	ACR–SIR 2011	ACCP guidelines 2012	ACCP guidelines 2008	ACCP guidelines 2004
PE or VTE on systemic anticoagulation	Recommend for under certain conditions^a	Recommend against IVCF (grade 1B)^b	Recommend against IVCF (grade 1A)	Recommend against IVCF (grade 1A)
Proximal DVT or PE and contraindication for systemic anticoagulation	Recommend IVCF	Recommend IVCF (grade 1B)^c	Recommend IVCF (grade 1C)	Recommend IVCF (grade 2C)
Recurrent VTE or PE despite adequate anticoagulation	Recommend IVCF	No recommendation for or against IVCF^d	No recommendation for or against IVCF^d	Recommend IVCF (grade 2C)
Trauma (for prophylaxis)	Consider IVCF	Recommend against IVCF (grade 2C)	Recommend against IVCF (grade 1C)	Recommend against IVCF (grade 1C)
Bariatric surgery (for prophylaxis)	No recommendation for or against IVCF	Recommend against IVCF (grade 2C)^e	No recommendation for or against IVCF^e	No recommendation for or against IVCF^e
Spinal cord injury (for prophylaxis)	Recommend IVCF	Recommend against IVCF (grade 2C)	Recommend against IVCF (grade 1C)	Recommend against IVCF (grade 1C)

ACCP = American College of Chest Physicians; ACR–SIR = American College of Radiology–Society of Interventional Radiology; DVT = deep vein thrombosis; IVCF = inferior vena cava filter; PE = pulmonary embolism; VTE = venous thromboembolism.

^aConditions for IVCF in patients on adequate anticoagulation include: recurrent PE or progression of DVT on adequate anticoagulation; massive PE with residual DVT and at risk of another PE; free-floating proximal thrombus; severe cardiopulmonary disease and DVT.

^bMay not apply to patients who are hemodynamically compromised.

^cACCP also recommends that, once the contraindications for systemic anticoagulation resolve, the patient should be treated with systemic anticoagulation with a conventional course. This should not be influenced or modified by the presence of the filter.

^dThe 2012 and 2008 ACCP guidelines do not explicitly comment on the use of IVCF for recurrent VTE despite adequate anticoagulation. However, the omission of an overt recommendation that was previously included in the 2004 guidelines suggests that it is no longer recommended.

^eIn the 2004 ACCP guidelines bariatric surgery patients are not included among the recommendations. In the 2008 guidelines bariatric patients are included, but no specific recommendations for or against IVCF are discussed (section 2.6). The 2012 guidelines recommend against prophylactic IVCF for general and abdominal-pelvic surgery patients, which we interpret to include bariatric surgery (section 3.6).