Use of inferior vena cava filters for treatment of VTE: SIR Guideline
Planned Filter Removal
- In patients in whom IVC filter removal is planned, we suggest against routine preprocedural imaging of the filter and the use of laboratory studies except in select situations, as outlined in the rationale.
Filter Removal without Standard Snare Techniques
- In patients undergoing filter retrieval whose filter could not be removed by using standard techniques, we suggest attempted removal with advanced techniques, if appropriate and if the expertise is available, after reevaluation of risks and benefits.
Filter Placement Technique
- In patients undergoing IVC filter placement, we cannot recommend for or against any specific placement technique.
“Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population,” concluded the authors.
"Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease," is published in the Journal of Vascular and Interventional Radiology.
DOI: https://www.jvir.org/article/S1051-0443(20)30531-5/fulltext
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.
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