• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home The Classics Emergency Classics

Vena caval filters in pulmonary embolism prophylaxis [Classics Series]

byMilana Bogorodskaya, MDandAndrew Cheung, MD MBA
January 12, 2015
in Emergency Classics, General Medicine Classics, Surgery Classics, The Classics
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

Image: PD

1. Permanent vena caval filter placement in addition to anticoagulant therapy helps prevent short-term occurrence of pulmonary embolism but increases the risk of recurrent DVT in the long-term

2. There is no significant difference in efficacy between LMWH and UFH during early anticoagulant therapy for PE prophylaxis

Original Date of Publication: February 1998

Study Rundown: In patients who are at high-risk for pulmonary embolism (PE) and have a contraindication to anticoagulation, an vena caval filter is a potential option to reduce the risk of PE. This multicenter, randomized study in France is the only randomized, controlled trial that has sought to determine whether filter placement decreases the incidence of PE, as well as deep vein thromboses (DVT) both in short-term and long-term follow-up. The study demonstrated that the use of a permanent vena caval filter in addition to heparin therapy reduced the occurrence of a PE in the short-term (OR 0.22; 95%CI 0.05-0.90). The data, however, also showed that in long-term follow-up of two years, there was a significant increase in recurrent DVTs in patients who received a filter (OR 1.87; 95%CI 1.10-3.20). This most likely relates to thrombosis at the filter site, but it may counteract the benefits gained earlier with the reduction in PE occurrence.

In summary, this study showed that filters lower the risk of PE in the short-term, but later increase the risk of recurrent DVT. It also confirmed the results of previous studies that showed no difference in effectiveness between low molecular-weight heparin (LMWH) and unfractionated heparin (UFH) for early anticoagulant therapy. Overall, the evidence in this study does not support the use of IVC filters in addition to anticoagulant therapy to prevent PE’s and recurrent DVT’s. Interestingly, this study excluded patients with DVT who had a contraindication to anticoagulation, which is one of the commonly cited indications for filter placement.

Click to read the study in NEJM

RELATED REPORTS

#VisualAbstract: Aspirin associated with significantly higher rate of symptomatic venous thromboembolism compared to enoxaparin in patients undergoing hip or knee arthroplasty

Aspirin associated with significantly higher rate of symptomatic venous thromboembolism compared to enoxaparin in patients undergoing hip or knee arthroplasty – the CRISTAL randomized trial

COVID-19 adenoviral but not mRNA vaccines are associated with adverse cardiovascular events

In-Depth [randomized, controlled study]: This study was a multicenter, non-blinded, 2×2, randomized-controlled trial that randomized 400 patients to vena caval filter placement or no placement, and to receive LMWH or UFH as a bridge to warfarin. Patients over 18 years of age with confirmed DVT with or without concomitant symptomatic pulmonary embolism, and whose physicians believed they were at high risk for a PE, were eligible for the study. Patients with history of IVC filter placement, contraindication to anticoagulant therapy, or likelihood of non-compliance were excluded. Two hundred patients were assigned to receive vena caval filters. One hundred ninety-five of the 400 total were assigned to LMWH while the other 205 were assigned to UFH for the first 8-12 days of anticoagulant therapy. The subjects underwent a baseline V/Q scan and/or pulmonary angiography to evaluate for a PE. All subjects were transitioned to warfarin therapy after 8-12 days for a duration of 3 months or maintained on UFH if oral anticoagulation was not possible. Patients were followed for 2 years. The primary outcome was occurrence of a PE within the first 12 days of anticoagulant therapy. The secondary outcome was occurrence of PE, DVT, major filter complication, and/or major bleeding during the follow-up period.

Filter vs. No Filter

The study demonstrated that there were significantly fewer patients (2 vs. 9 patients) in the filter group compared to the non-filter group who had had a pulmonary embolism in the first 12 days of anticoagulation therapy (OR 0.22; 95%CI 0.05-0.90). Results were similar when analysis was adjusted for heparin therapy and presence of PE at enrollment. In the 2-year follow-up, there was a significantly higher number of recurrent DVTs in the filter group compared to the no-filter group (OR 1.87; 95%CI 1.10-3.20). There was no significant difference in PE incidence, mortality, or major bleeding between the two groups at the 2-year mark.

LMWH vs. UFH

There was no significant difference in incidence of PE’s or DVTs between the two anticoagulant groups during the first 12 days as well as the 2-year mark. There was also no statistical significance in mortality or adverse effects between the two groups.

There was no evidence of statistically significant interaction between filter and heparin anticoagulant therapy for both primary and secondary outcome events.

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. No article should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2 Minute Medicine, Inc.

Tags: pulmonary embolism
Previous Post

Letrozole superior to clomid for ovulation induction in PCOS [Classics Series]

Next Post

Stroke expansion following intra-arterial therapy may explain worse outcomes

RelatedReports

#VisualAbstract: Nirmatrelvir associated with improved COVID-19 outcomes in older adults
StudyGraphics

#VisualAbstract: Aspirin associated with significantly higher rate of symptomatic venous thromboembolism compared to enoxaparin in patients undergoing hip or knee arthroplasty

September 8, 2022
Patient Basics: Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism)
Hematology

Aspirin associated with significantly higher rate of symptomatic venous thromboembolism compared to enoxaparin in patients undergoing hip or knee arthroplasty – the CRISTAL randomized trial

September 2, 2022
AAP supports mandatory influenza vaccination of health care providers
Infectious Disease

COVID-19 adenoviral but not mRNA vaccines are associated with adverse cardiovascular events

September 5, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Radiology Classics

The PIOPED II trial: CT sensitive and specific for pulmonary embolism [Classics Series]

August 11, 2022
Next Post
Stroke expansion following intra-arterial therapy may explain worse outcomes

Stroke expansion following intra-arterial therapy may explain worse outcomes

No benefit of erlotinib in combined hepatocellular carcinoma treatment

No benefit of erlotinib in combined hepatocellular carcinoma treatment

Severe psoriasis linked with poorly controlled blood pressure

Brodalumab may be effective for difficult-to-treat psoriasis

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Transcarotid artery revascularization not associated with a significant difference in 30-day risk of stroke, death and myocardial infarction compared to carotid endarterectomy
  • Drinking characteristics in adolescence predict alcohol behaviors in early adulthood
  • Sodium-glucose co-transporter-2 inhibitors may decrease risk of in-stent thrombosis
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options