Pulmonary embolism guidelines inferior vena cava filter

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
An inferior vena cava filter, is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli (PEs).

IVC filters are used in the following cases :
 * 1) Anticoagulation is contraindicated
 * 2) Failure of anticoagulation
 * 3) Complication to anticoagulation in patients who have a venous thromboembolism disease.
 * 4) Prophylactic measure for patients with high risk of pulmonary embolism.

ACC/AHA Guidelines- Recommendations on IVC Filters in the Setting of Acute PE (DO NOT EDIT)
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Class I
1. Adult patients with any confirmed acute PE (or proximal DVT) with contraindications to anticoagulation or with active bleeding complication should receive an IVC filter. (Level of Evidence: C)

2. Anticoagulation should be resumed in patients with an IVC filter once contraindications to anticoagulation or active bleeding complications have resolved. (Level of Evidence: B)

3. Patients who receive retrievable IVC filters should be evaluated periodically for filter retrieval within the specific filter's retrieval window. (Level of Evidence: C)

Class IIa
4. For patients with recurrent acute PE despite therapeutic anticoagulation, it is reasonable to place an IVC filter (Level of Evidence: C)

5. For DVT or PE patients who will require permanent IVC filtration (eg, those with a long-term contraindication to anticoagulation), it is reasonable to select a permanent IVC filter device. (Level of Evidence: C).

6. For DVT or PE patients with a time-limited indication for an IVC filter (eg, those with a short-term contraindication to anticoagulation therapy), it is reasonable to select a retrievable IVC filter device. (Level of Evidence: C).

Class IIb
7. Placement of an IVC filter may be considered for patients with acute PE and very poor cardiopulmonary reserve, including those with massive PE. (Level of Evidence: C).

Class III
8. An IVC filter should not be used routinely as an adjuvant to anticoagulation and systemic fibrinolysis in the treatment of acute PE. (Level of Evidence: C)}}.

==ACC/AHA Guidelines- Recommendations for Use of IVC Filters in Patients With Iliofemoral DVT (DO NOT EDIT) ==

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Class I
1. Adult patients with any acute proximal DVT (or acute PE) with contraindications to anticoagulation or active bleeding complication should receive an IVC filter (Level of Evidence: B).

2. Anticoagulation should be resumed in patients with an IVC filter once contraindications to anticoagulation or active bleeding complications have resolved (Level of Evidence: B).

3. Patients who receive retrievable IVC filters should be evaluated periodically for filter retrieval within the specific filter's retrieval window (Level of Evidence: C).

Class IIa
4. For patients with recurrent PE despite therapeutic anticoagulation, it is reasonable to place an IVC filter (Level of Evidence: C).

5. For iliofemoral DVT patients who are likely to require permanent IVC filtration (eg, long-term contraindication to anticoagulation), it is reasonable to select a permanent nonretrievable IVC filter device (Level of Evidence: C).

6. For iliofemoral DVT patients with a time-limited indication for an IVC filter (eg, a short-term contraindication to anticoagulant therapy), placement of a retrievable IVC filter is reasonable (Level of Evidence: C).

Class IIb
7. For patients with recurrent DVT (without PE) despite therapeutic anticoagulation, it is reasonable to place an IVC filter(Level of Evidence: C).

Class III
8. An IVC filter should not be used routinely in the treatment of iliofemoral DVT (Level of Evidence: B)}}.

ESC Guidelines - Recommendations for Use of IVC Filters (DO NOT EDIT)
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Class IIb
1.IVC filters may be used when there are absolute contraindications to anticoagulation and a high risk of VTE recurrence.(Level of Evidence: B)

Class III
2.The routine use of IVC filters in patients with PE is not recommended.(Level of Evidence: B)}}''.

Guidelines Resources

 * Guidelines on the management of Pulmonary embolism: Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension
 * Guidelines on the diagnosis and management of acute pulmonary embolism.