To browse Academia. OBJECTIVE To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence.
Initial hospitalization with ambulatory follow-up occurred in 17 French centers. Insertion of a retrievable inferior vena cava filter in patients randomized to the filter group. Filter retrieval was planned at 3 months from placement. Secondary outcomes were recurrent pulmonary embolism at 6 months, symptomatic deep vein thrombosis, major bleeding, death at 3 and 6 months, and filter complications.
RESULTS In the filter group, the filter was successfully inserted in patients and was retrieved as planned in of the patients in whom retrieval was attempted. By 3 months, recurrent pulmonary embolism had occurred in 6 patients 3. Results were similar at 6 months. No difference was observed between the 2 groups regarding the other outcomes. Filter thrombosis occurred in 3 patients.
These findings do not support the use of this type of filter in patients who can be treated with anticoagulation. Cases of pulmonary embolism PE with contraindication of anticoagulation have low incidence. Under these circumstances the placement of an inferior vena cava IVC filter may be life-saving. Paradoxically, the presence of the filter imposes anticoagulation itself, due to the risk of filter thrombosis, promoting stasis and increasing the risk of filter related deep venous thrombosis DVT and PE recurrence by means of a substantial collateral venous return that bypasses the IVC filter 1,2.
After thrombolysis with alteplase the patient develops retroperitoneal hematoma originating from undiagnosed renal angiomyolipoma. Therefore long term anticoagulation is considered contraindicated and an IVC filter is installed. The initiation of low molecular weight heparin and afterwards of acenocumarol has a favorable outc Background: Previous observational studies suggest that inferior vena cava filter placement in pulmonary embolism patients complicated with congestive heart failure, mechanical ventilation, and shock may have a mortality benefit.
