Guidelines on use of vena cava filters

Abstract

Summary of key recommendations • VC filters are indicated to prevent pulmonary embolus(PE) in patients with venous thromboembolism (VTE)who have a contraindication to anticoagulation (grade B,level III).• Anticoagulation should be considered in patients with aVC filter when a temporary contraindication to antico-agulant therapy is no longer present. Insufficient dataexists to support a recommendation that all filter recip-ients should be treated with indefinite anticoagulationregardless of their risk of recurrent thrombosis (grade C,level IV). The decision as to whether or not to introduceanticoagulant therapy should be based on the perceivedunderlying thrombotic risk of the condition and thelikelihood of anticoagulant therapy-related bleeding.• VC filters are not indicated in unselected patients withVTE who will receive conventional anticoagulant therapy(grade A, level Ib).• VC filter insertion may be considered in selected patientswith PE despite therapeutic anticoagulation. Alternativetreatment options, such as long-term high-intensity oralanticoagulant therapy [international normalised ratio(INR) target 3AE5] or low molecular weight heparin(LMWH), should be considered prior to VC filterplacement, particularly in patients with thrombophilicdisorders (e.g. antiphospholipid syndrome) or cancer(grade C, level IV).• VC filter insertion may be considered in pregnantpatients who have contraindications to anticoagulationor develop extensive VTE shortly before delivery (within2 weeks). Retrievable filters should be considered (gradeC, level IV).• Free-floating thrombus is not an indication for insertionof a VC filter (grade B, level III).• Thrombolysis is not an indication for filter insertion. If afilter is used a retrievable filter should be used if available(grade C, level IV).• VC filters should be considered in any pre-operativepatient with recent VTE (within 1 month) in whomanticoagulation must be interrupted. Retrievable VCfilters should be considered in this situation where atemporary contraindication to anticoagulation exists(grade C, level IV).• No particular filter appears superior to others. Removablefilters should be used, if available, for patients with ashort-term contraindication to anticoagulant therapy(e.g. approximately 2 weeks) (grade C, level IV).