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inferior vena cava filter
An inferior vena cava filter (IVC filter) is a type of vascular filter, a medical device that is implanted by interventional radiologists or vascular surgeons into the inferior vena cava to presumably prevent life-threatening pulmonary emboli (PEs). Their effectiveness and safety profile is not well established, and in general, they are only recommended in some high-risk scenarios.〔 They are not intended to be a replacement for medical (drug-based) management of venous thromboembolism (VTE). However, in cases where patients are at high risk of developing a clinically significant PE and cannot be sufficiently anticoagulated, placement of an IVC filter may be recommended.〔
To date, there has been only one randomized controlled trial completed on IVC filters. This study found that IVC filters reduced the incidence of PE but increased the incidence of deep vein thrombosis (DVT). All patients were on anticoagulation drugs during the study. Results from the PREPIC study and other studies which have shown many long-term complications of IVC filters led to the introduction of retrievable IVC filters. The first retrievable IVC filters were approved by FDA in 2003 and 2004.
In 2012, the American College of Chest Physicians recommended IVC filters for those with contraindications to anticoagulation who either have acute PE or acute proximal (above the knee) deep vein thrombosis (DVT).〔Guyatt ''et al''. 2012, p. 21S: 2.13.2.〕〔Guyatt ''et al''. 2012, p. 24S: 5.9.2.〕
==Anticoagulation==
In those with initial acute proximal DVT or acute PE who had IVC filters placed instead of anticoagulation, and who have their risk of bleeding resolve, the American College of Chest Physicians suggested, in 2012, that they receive a standard course of anticoagulation.〔Guyatt ''et al''. 2012, p. 21S: 2.13.3.〕〔Guyatt ''et al''. 2012, p. 24S: 5.9.3.〕 While IVC filters are associated with a long term risk of DVT,〔 they are not, alone, reason enough to maintain extended anticoagulation.〔Guyatt ''et al''. 2012, p. 21S: 2.13.〕
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