What are the AHA guidelines for use of vena cava filters in 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

Recommendations for use of vena cava filters include the following:

  • Patients with confirmed acute PE (or proximal deep venous thrombosis [DVT]) with contraindications to anticoagulation or with active bleeding complications should receive an inferior vena cava (IVC) filter (class I).
  • Anticoagulation should be resumed in patients with an IVC filter once contraindications to anticoagulation or active bleeding complications have resolved (class I).
  • Patients who receive retrievable IVC filters should be evaluated periodically for filter retrieval within the specific filter’s retrieval window (class I).
  • Placement of an IVC filter is reasonable for patients with recurrent acute PE despite therapeutic anticoagulation (class IIa).
  • A permanent IVC filter device is reasonable for patients with a long-term contraindication to anticoagulation (class IIa).
  • A retrievable IVC filter device is reasonable for patients with a short-term contraindication to anticoagulation therapy (class IIa).
  • Placement of an IVC filter may be considered for patients with acute PE and very poor cardiopulmonary reserve, including those with massive PE (class IIb).
  • An IVC filter should not be used routinely as an adjuvant to anticoagulation and systemic fibrinolysis in the treatment of acute PE (class III).

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