HOLLYWOOD, Fla. — Overuse of inferior vena cava filters is not as much of a problem as it used to be, but inappropriate use still occurs and retrieval too often does not happen quickly enough, an expert said at the International Symposium on Endovascular Therapy.
IVC filters have been linked to serious complications if left in too long, so using them only in the right patients and retrieving them as soon as their task is complete is paramount, Akhilesh Sista, MD, FSIR, section chief and associate professor at New York University Langone School of Medicine, said during a presentation.
“There are real consequences to liberal placement practice,” he said. “Migration and thrombosis rates are low but cannot be ignored.”
IVC filters are placed in patients with deep vein thrombosis, especially those who are contraindicated for anticoagulation, because data support that they prevent pulmonary embolism, he said.
However, Sista said, the recent PREPIC 2 trial found no significant differences in PE or mortality rates between those who received a filter plus anticoagulation and those who received anticoagulation alone.
In 2016, he noted, the American College of Chest Physicians changed its guidelines to recommend against IVC filters in patients with acute DVT and PE who can be anticoagulated.
Too many filters are left in too long, Sista said. “There are two problems with long-dwelling filters,” he said. “They are harder to remove and there is higher potential for complications, including IVC tear.”
Filters should be considered for patients who cannot be anticoagulated and for those who fail anticoagulation for proximal DVT or PE. Beyond that, he said, only patients with massive PE should get them, noting that in that population, patients with filters have much lower rates of mortality than patients without filters.
Insertion of IVC filters has declined since 2006, when concerns started to mount, culminating in 2010 when the FDA issued a warning about complications related to IVC filter use and recommended retrieval between 29 and 54 days in most cases. However, as of 2015 the rate had not returned to the levels seen in the mid-90s, and retrieval rates remain low, Sista said.
“Filter utilization was overexuberant and is correcting, but probably incompletely,” he said. “We are still not retrieving enough filters within the recommended time of retrieval.” – by Erik Swain
Sista A. Clot management and venous interventions. Presented at: the International Symposium on Endovascular Therapy (ISET); Jan. 27-30, 2019; Hollywood, Fla.
Disclosure: Sista reports he received an institutional research grant from Penumbra and serves as an unpaid advisory board member for Thrombolex.