When is an inferior vena cava (IVC) filter indicated for PE prophylaxis?

Updated: Oct 31, 2020
  • Author: Gary P Siskin, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR  more...
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Answer

Answer

IVC filter placement has been advocated as a means of preventing PE in patients at high risk for thromboembolic events. Traditionally, such patients have included the following populations:

  • Patients with DVT who are about to undergo surgery (lower-extremity orthopedic surgery, major abdominal surgery, neurosurgery)

  • Patients with chronic pulmonary hypertension and a marginal cardiopulmonary reserve

  • Patients with cancer

  • Trauma patients, including those with (1) severe head injury with prolonged ventilator dependence, (2) major abdominal or pelvic penetrating venous injury, (3) spinal cord injury with or without paralysis, (4) severe head injury with multiple lower-extremity fractures, or (5) pelvic fracture with or without lower-extremity fractures

In 1981, Moore et al reported 21 hemorrhagic events in 32 patients with malignancy who underwent anticoagulation therapy to treat thromboembolic disease. [99] Of these patients, 8 had hemorrhage resulting in cessation of therapy or death. This observation led to the conclusion that IVC filter placement is a safer means for PE prophylaxis. [99] However, this indication was disputed in 1998 by the American College of Chest Physicians Consensus Committee on Pulmonary Embolism [100] ; its report stated that the routine use of IVC filters is not recommended in patients with cancer and DVT or PE. [101]

Patients with severe trauma are prone to develop DVT and PE. In many of these patients, anticoagulation therapy is contraindicated because of the risk of hemorrhage. Other conservative methods, including compression devices and foot pumps, may not adequately prevent DVT. Although some studies have shown that the prophylactic placement of IVC filters prevents fatal PE in patients with trauma, other studies have not shown any significant reduction in the rate of PE. Additional studies of cost-effectiveness or risk-benefit considerations do not support prophylactic filter placement in patients with trauma. [102]


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