IVC Filters: Indications and Evidence
- Volume 6 - Issue 6 - Nov/Dec 2009
- Posted on: 11/7/09
- 1 Comments
- 34246 reads
Neil J. Rane, MD and Raman Uberoi, MD
The role of IVC filters in the treatment of VTE is still unclear. What we can say with some certainty is that in most patients IVC filters do not confer additional benefit compared to being treated solely with anticoagulation for DVT with or without PE. However, there are certain absolute indications that have good evidence basis. These are embraced by most major guidelines. Extended indications remain to be tested in a systematic way. Furthermore, there may still be a role for a combination of anticoagulants and filters in a super-selected group.
The literature is clouded with studies that examine certain filters and make meta-analysis difficult. The question of which IVC filter to use still remains largely unanswered. It is still unclear as to whether anticoagulation should be concomitantly instituted with filter insertion.
The advent of temporary filters adds yet a further level of complexity. There is currently no RCT evidence examining the efficacy of temporary filters. Such devices are in vogue, however, the evidence for their long-term safety is not robust and hence all such cases should receive regular follow up. With all this in mind, the decision to insert a filter should not be taken lightly, nor should it be made in isolation.