CHEST Guidelines--strong-POINT---strong--Do-the-Benefits-Outweigh-t

-strong-POINT---strong--Do-the-Benefits-Outweigh-t

Pdf Summary

The debate on the use of Inferior Vena Cava (IVC) filters in patients with deep vein thrombosis (DVT) who cannot undergo anticoagulation revolves around the balance between their benefits and risks. Proponents, including Brian Funaki, MD, and Ziv J. Haskal, MD, assert that IVC filters effectively prevent pulmonary embolisms (PE) by trapping clots, similar to how a colander catches pasta. While comprehensive data from randomized trials comparing filter placements to no therapy are sparse, they argue it would be unethical to withhold such a potentially lifesaving intervention.<br /><br />Historical studies, such as one from 1973, demonstrated that prophylactic filters drastically reduced the incidence of PE and related deaths compared to the control group. Although recent randomized trials like the PREPIC studies showed no significant mortality benefit over anticoagulation alone, critics suggest these trials were not aligned with the main indication for filter use—patients ineligible for anticoagulation. Proponents advocate for filter use in high-risk patients for whom anticoagulation poses risks, with the recommendation for filter removal once the initial risk period passes to minimize complications such as thrombosis or device migration.<br /><br />Critics, however, led by Mark L. Lessne, MD, and Ronald F. Sing, DO, argue that the extensive use of IVC filters lacks strong evidence of efficacy. Despite the substantial number of filters implanted annually, complication rates and risks, such as increased deep vein thrombosis, necessitate careful consideration. Critics also point to the liberalization of filter indications and low retrieval rates for retrievable filters as concerns that lead to unnecessary complications.<br /><br />Ultimately, supporters of IVC filters underscore their role in certain high-risk patients, emphasizing the need for systematic retrieval and ongoing studies, like the PRESERVE trial, to better understand their long-term safety and efficacy.

Keywords

IVC filters

deep vein thrombosis

anticoagulation

pulmonary embolism

Brian Funaki

Ziv J. Haskal

PREPIC studies

high-risk patients

filter complications

PRESERVE trial