USA: The Society of Interventional Radiology (SIR) has released recent guideline on the use of inferior vena cava (IVC) filters for the treatment of patients with venous thromboembolic disease. The guideline is published in the Journal of Vascular and Interventional Radiology.
The guideline was developed by SIR in collaboration with the American College of Cardiology (ACC), the American College of Chest Physicians (ACCP), the American College of Surgeons (ACS) Committee on Trauma, the American Heart Association (AHA), the Society for Vascular Surgery (SVS), and the Society for Vascular Medicine (SVM).
In this clinical practice guideline, the authors provide evidence-based recommendations balancing the benefits and harms associated with the use, placement, and removal/conversion of IVC filters in the treatment of venous thromboembolism (VTE) and prevention of pulmonary embolism (PE).
Key recommendations include:
Acute PE
In patients with acute PE with a contraindication to anticoagulation therapy, we suggest an IVC filter be considered based on various clinical risk factors, as outlined in the rationale.
Acute DVT
In patients with acute DVT without PE and with a contraindication to anticoagulation therapy, we suggest that an IVC filter be considered based on various clinical risk factors, as outlined in the rationale.
Anticoagulation for VTE
In patients with acute DVT without PE and with a contraindication to anticoagulation therapy, we suggest that an IVC filter be considered based on various clinical risk factors, as outlined in the rationale.
In patients undergoing extended anticoagulation for VTE (DVT, PE) and have completed the acute phase of treatment in whom a contraindication to anticoagulation develops, we suggest that an IVC filter not be placed, with rare exceptions.
Recurrent VTE
In patients who are receiving therapeutic anticoagulation for VTE (DVT, PE) who experience a recurrent VTE, we suggest that a filter not be placed, with few exceptions. Reasons for anticoagulation failure should always be addressed.
Routine IVC Filter Placement
In patients with acute VTE (DVT, PE) who are being treated with therapeutic anticoagulation, we recommend against routine placement of an IVC filter.
PE with Advanced Therapies
In patients with acute VTE (DVT, PE) who are being treated with therapeutic anticoagulation, we recommend against routine placement of an IVC filter.