Recommendations
25.

Consider inferior vena caval filters for patients with recurrent proximal DVT or PE despite adequate anticoagulation treatment only after considering alternative treatments such as:

Relative values of different outcomesThe risk of mortality, the risk of recurrent PE and the risk of major bleeding were all considered to be important outcomes. The risk of recurrent PE was considered to be the most important of these outcomes. The risk of DVT increases with the placement of IVC filters
Trade off between clinical benefits and harmsThe benefit of avoiding a PE or a recurrent PE, was compared to the risk of increased bleeding, and risk of DVT.
Economic considerationsNo economic evidence was found for patients who have recurrent VTE despite adequate anticoagulation treatment. Both IVC filter and oral anticoagulant therapy are associated with costs. The recommendation was based mainly on clinical reasons.
Quality of evidenceNo evidence was available for temporary filters. The evidence available was in permanent filters
This recommendation was developed based on GDG consensus.
Other considerationsSome patients may have recurrent VTE despite adequate anticoagulation.

This recommendation is a ’consider’ recommendation because there is no evidence relating to current practice with temporary filters.

The GDG discussed that in regards to a patients’ quality of life, the insertion of a filter may be preferable to lifelong injections of anticoagulation for some patients, although this must be balanced against the higher risk of DVT and PTS.

From: 10, Mechanical Interventions

Cover of Venous Thromboembolic Diseases
Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet].
NICE Clinical Guidelines, No. 144.
National Clinical Guideline Centre (UK).
Copyright © 2012, National Clinical Guideline Centre.

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