II. Indications: Prevent embolism in Deep Vein Thrombosis
-
Anticoagulation contraindicated (Fall Risk, Bleeding risk)
- High risk Hypercoagulable patients or
- High risk of Pulmonary Embolism (e.g. proximal DVT)
- Prolonged bed-bound status (e.g Trauma, paralysis, Severe Head Injury, Hip Fracture, Pelvic Fracture, Bariatric Surgery)
- Complication secondary to Anticoagulation
- Failed Anticoagulation
- Deep Vein Thrombosis extension
- Pulmonary Embolism despite Anticoagulation with therapeutic levels
- Hemorrhage
- Thrombocytopenia
- Warfarin skin necrosis
- Noncompliance with Anticoagulation protocol
- Failed Anticoagulation
III. Efficacy
- Lower Incidence of Pulmonary Embolism
- Does not reduce overall mortality
- Decousus (1998) N Engl J Med 12:338(7):409-15 [PubMed]
- Young (2010) Cochrane Database Syst Rev, CD006212
IV. Complications
- Overall complication rate: 1-2%
- Early complications
- Malpositioned IVC Filter (e.g. tilted)
- Insertion site Hematoma
- Deployment complication (e.g. filter fails to open completely)
- Late complications
- IVC Filter migration (e.g. into right atrium or superior vena cava)
- IVC Filter tilted or otherwise malpositioned
- IVC thrombosis
- IVC perforation (e.g. due to IVC Filter leg or strut fracturing)
- References
V. Precautions
- IVC Filters should only be used as bridging devices and then removed
- Risk of Pulmonary Embolism wanes
- Anticoagulation is no longer contraindicated
- FDA recommends removal of IVC Filter when no longer indicated
- However removal is difficult and fails in up to 8% of cases
- Lee (2015) Cardiovasc Intervent Radiol 38(6): 1502-7 [PubMed]
VI. References
- Shoenberger and Bright in Majoewsky (2013) EM:Rap 13(6): 8
- Girard (2002) Chest 122:963-7 [PubMed]