Chest

Chest

Volume 137, Issue 4, April 2010, Pages 877-882
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Original Research
Antithrombotic Therapy
Vena Cava Filter Occlusion and Venous Thromboembolism Risk in Persistently Anticoagulated Patients: A Prospective, Observational Cohort Study

https://doi.org/10.1378/chest.09-1533Get rights and content

Background

Inferior vena cava (IVC) filter placement may be life-saving, but after contraindications to anticoagulation remit, patient management is uncertain.

Methods

We followed patients who had venous thromboembolism, followed by treatment with permanent IVC filter placement, and were anticoagulated long-term as soon as safety allowed. We conducted annual physical examinations and ultrasound surveillance of the lower extremity deep veins and of the IVC filter site. Clot detected at the filter site was treated with graded intensities of anticoagulation, depending on the clot burden.

Results

Symptomatic DVT occurred in 24 of 121 patients (20%; 95% CI, 14%-28%); symptomatic pulmonary embolism (one fatal) was diagnosed in six patients (5%; 95% CI, 2%-10%). There were 45 episodes of filter clot in 36 patients (30%; 95% CI, 22%-38%). The rate of major bleeding (6.6%) was similar to that of a concurrent persistently anticoagulated cohort without IVC filters (5.8%).

Conclusions

If therapeutic anticoagulation can be safely begun in patients with IVC filters inserted after venous thromboembolism, further management with clinical surveillance, including ultrasound examination of the IVC filter and graded degrees of anticoagulation therapy if filter clot is detected, has a favorable prognosis. This approach appears valid for patients with current IVC filter and can serve as a comparison standard in subsequent clinical trials to optimize clinical management of these patients.

Section snippets

Patients and General Study Procedures

Consecutive eligible patients treated in the National Tuberculosis and Lung Diseases Research Institute in Warsaw were invited to give written informed consent and join the study, which had been previously approved by the Institute's Ethical Committee. Eligible patients included those with DVT or PE in whom permanent IVC filters were placed and in whom anticoagulant treatment with warfarin at a therapeutic level was either initiated immediately or as soon as not contraindicated and continued

Results

One hundred twenty-one IVC filter recipients were enrolled, 73 men and 48 women aged 15 to 81 years (mean age 56, SD 15). Indications for filter placement and types of filters placed are shown in Table 1. All were permanent and placed percutaneously below the renal vein with fluoroscopic guidance. The contemporary cohort of persistently anticoagulated patients without filters, enrolled to compare bleeding risk, included 120 patients, 57 men and 63 women aged 13 to 81 years (mean age 55, SD 15).

Discussion

In this prospective study, we found that patients with IVC filters could be managed with long-term OA therapy with acceptable risks of VTE recurrence and major bleeding. IVC filter clots occurred, were rarely symptomatic, and using the management protocol we describe, resolved, although they occasionally recurred. Bleeding risk in these patients appeared similar to that of a contemporary cohort of other patients on long-term OA. For patients living with IVC filters, either from before the era

Acknowledgments

Author contributions: Dr Hajduk: contributed to planning the study; enrolling and following the patients; analyzing and interpreting data; and drafting, critical review, and final approval of the article.

Dr Tomkowski: contributed to planning the study; enrolling and following the patients; analyzing and interpreting data; and drafting, critical review, and final approval of the article.

Dr Małek: contributed to planning the study; enrolling and following the patients; analyzing and interpreting

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Copyright © 2010 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.