When are vena cava filters indicated in the treatment of pulmonary embolism (PE)?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Patients with acute PE should not routinely receive vena cava filters in addition to anticoagulants. [5] An ideal IVC filter should be easily and safely placed using a percutaneous technique, biocompatible and mechanically stable, and able to trap emboli without causing occlusion of the vena cava. [105]

IVC interruption by the insertion of an IVC filter (Greenfield filter) is only indicated in the following settings:

  • Patients with acute venous thromboembolism who have an absolute contraindication to anticoagulant therapy (eg, recent surgery, hemorrhagic stroke, significant active or recent bleeding)

  • Patients with massive PE who survived but in whom recurrent embolism invariably will be fatal

  • Patients who have objectively documented recurrent venous thromboembolism, adequate anticoagulant therapy notwithstanding

In patients with a time-limited indication for IVC filter placement (eg, a short-term contraindication to anticoagulation), it is reasonable to select a retrievable IVC filter and evaluate the patient periodically for filter retrieval. After placement of an IVC filter, anticoagulation should be resumed once contraindications to anticoagulation or active bleeding complications have resolved. [104]


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