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IVC Filters to Prevent Pulmonary Embolism
Study Questions:
What is the safety and efficacy of inferior vena cava (IVC) filters?
Methods:
Using a systematic review and meta-analysis of published literature through October 3, 2016 of randomized controlled trials (RCTs) or prospective observational studies, the authors measured the efficacy and safety of IVC filters in patients at risk of pulmonary embolism (PE).
Results:
The systematic review included 11 studies (six RCTs and five observational), of which the RCTs were low-moderate quality of evidence. Overall, patients receiving IVC filters had a lower risk for subsequent PE (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.33-0.75), increased risk for deep vein thrombosis (DVT; OR 1.70; 95% CI, 1.17-2.48), a nonsignificant lower PE-related mortality (OR, 0.51; 95% CI, 0.25-1.05), and no change in all-cause mortality (OR, 0.91; 95% CI, 0.70-1.19). Similar findings were present when analyses were restricted to RCTs only.
Conclusions:
The authors concluded that among a small number of low-moderate quality studies, IVC filters appear to reduce the risk of subsequent PE, increase the risk of DVT, and have no impact on overall mortality.
Perspective:
There is much debate about the role, efficacy, and safety of IVC filters for the prevention of PE. This systematic review highlights the small amount and relatively low quality of studies to explore this association. Nonetheless, use of IVC filters was associated with lower risk of PE and higher risk of DVT without any change in mortality. Doctors should continue to be selective in the use of IVC filters, limiting their use to patients most likely to benefit. For patients who get IVC filters, constant re-assessment of need and appropriateness of removal are of particular importance to avoid long-term complications.
Keywords: Anticoagulants, Primary Prevention, Pulmonary Embolism, Risk, Thrombosis, Vascular Diseases, Vena Cava Filters, Vena Cava, Inferior, Venous Thrombosis
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