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European guidelines on perioperative venous thromboembolism prophylaxis: Inferior vena cava filters

Comes, Raquel Ferrandis; Mismetti, Patrick; Afshari, Arashfor the ESA VTE Guidelines Task Force

European Journal of Anaesthesiology (EJA): February 2018 - Volume 35 - Issue 2 - p 108–111
doi: 10.1097/EJA.0000000000000730
Guidelines

The indications for the use of an inferior vena cava filter (IVCF) in the context of deep venous thrombosis to prevent pulmonary embolism remain controversial. Despite wide use in clinical practice, great variation exists in national and international guidelines in regard to the indications. In addition, clinical practice is based on poor-quality data from trauma and bariatric surgery with a high incidence of complications. It is often difficult to assess their efficacy and lack of filter retrieval appears to be a substantial issue compared with a potential benefit by insertion of these devices. Complications usually refer to increased risk of deep venous thrombosis, filter perforation, filter penetration, filter migration, inferior vena cava occlusion and subsequently failure in pulmonary embolism prevention. Evidence from low-quality studies or registries, with small numbers of patients and conflicting findings, does not allow for a strong recommendation for or against the use of IVCFs. IVCFs should only be considered in cases of very high risk of pulmonary embolism and in perioperative situations at very high risk of bleeding, resulting in a prolonged contra-indication to pharmacological prophylaxis.

From the Hospital Universitari i Politècnic La Fe, València, Spain (RFC), Unité de Recherche Clinique, Innovation et Pharmacologie, Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne, France (PM) and Department of Anesthesia, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA)

Correspondence to Arash Afshari, MD, PhD, Department of Anesthesia, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, 4013-4014, Blegdamsvej 9, 2100 Copenhagen, Denmark Tel: +45 35458749; e-mail: arash.afshari@regionh.dk

Published online 6 November 2017

© 2018 European Society of Anaesthesiology