IVC filter does not reduce risk of clotting and increases complications in patients who can tolerate anticoagulation

  • There are two main studies on IVC filter in general patient who can tolerate anticoagulation: PREPIC 1 and 2
  • Both compared patients on IVC filter + anticoagulation vs anticoagulation alone
  • PREPIC 1 studied permanent IVC filter, whereas PREPIC 2 studied retrievable filter
  • PREPIC-1 study patients with IVC filter are more likely to have new DVT and less likely to have PE at 8 years follow up
    • There is no mortality benefit.1
  • PREPIC-2 compared 3 and 6 months follow up.
    • patients with IVC filters have more absolute increase in recurrent PE and mortality but no statistic difference.2
  • Conclusion from 2 studies:
    • IVC filter does not reduce mortality risks
    • IVC filter increases DVT and filter complications
    • IVC filter may or may not reduce new PE incidence.3
  • These 2 trials are limited in their patient population and do not study cancer patients or patients with bleeding complications on blood thinners
  • IVC filter may be beneficial in patients with cancer and bleeding

Footnotes

  1. Decousus H, Leizorovicz A, Parent F, et al. A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis. N Engl J Med. 1998;338(7):409-416. doi:10.1056/NEJM199802123380701 ↩

  2. Mismetti P, Laporte S, Pellerin O, et al. Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism: A Randomized Clinical Trial. JAMA. 2015;313(16):1627–1635. doi:10.1001/jama.2015.3780 ↩

  3. https://emcrit.org/pulmcrit/what-is-the-evidence-behind-the-ivc-filter/ ↩