What's new in pulmonary and critical care medicine
Inferior vena cava (IVC) filters are not routinely inserted in patients with acute DVT. Typically, IVC filters are used in patients with acute proximal DVT and pulmonary embolism (PE) who have an absolute contraindication to anticoagulant therapy (eg, recent surgery, hemorrhagic stroke, active bleeding). Although not considered absolute indications, placement of an IVC filter is also often considered as an adjunctive therapy in patients with recurrent embolism despite adequate anticoagulation, as well as in patients in whom an additional embolic event would be poorly tolerated (eg, those with poor cardiopulmonary reserve from massive PE or underlying cardiopulmonary disease, hemodynamically unstable patients). The efficacy of IVC filter placement in patients with isolated distal DVT is unknown. Filters are typically placed in the infrarenal portion of the IVC; as such, their major purpose is the prevention of embolization of lower extremity clot to the lung. In general, we prefer retrievable filters but the compliance with retrieval tends to be low. (See "Placement of vena cava filters and their complications".)
For patients in whom an IVC filter is placed, we and others agree that once the risk of bleeding is assessed as low that a conventional course of anticoagulation therapy should be administered and the filter removed, when feasible.
The many types of filters that are available, some of which are approved by regulatory agencies, are listed in the table. However, there are no data to suggest that one type of filter is superior to another. Continue>
Posted in: News Briefs | May 21, 2014
Posted in: News Briefs | June 5, 2014
Posted in: News Briefs | January 22, 2014