Guidelines for Use of Inferior Vena Cava Filters in Treatment of Venous Thromboembolism (SIR, 2020)

Society of Interventional Radiology (SIR)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 18, 2020

The guidelines on the use of inferior vena cava (IVC) filters in the treatment of patients with venous thromboembolism (VTE; ie, deep vein thrombosis [DVT] or pulmonary embolism [PE]) were published in October 2020 by the Society of Interventional Radiology (SIR), in collaboration with the American College of Cardiology (ACC), the American College of Chest Physicians (ACCP), the American College of Surgeons (ACS) Committee on Trauma, the American Heart Association (AHA), the Society for Vascular Surgery (SVS), and the Society for Vascular Medicine (SVM).[1]

In patients with acute PE who have a contraindication for anticoagulation therapy, consideration of IVC filter placement is suggested on the basis of various clinical risk factors.

In patients with acute DVT without PE who have a contraindication for anticoagulation therapy, consideration of IVC filter placement is suggested on the basis of various clinical risk factors.

In patients undergoing anticoagulation for acute VTE in whom a contraindication for anticoagulation develops, consideration of an IVC filter is suggested if there is ongoing significant clinical risk for PE.

In patients undergoing extended anticoagulation for VTE who have completed the acute phase of treatment and in whom a contraindication to anticoagulation develops, it is suggested that an IVC filter not be placed, with rare exceptions.

In patients receiving therapeutic anticoagulation for VTE who experience recurrent VTE, it is suggested that an IVC filter not be placed, with few exceptions. Reasons for anticoagulation failure should always be addressed.

In patients with acute VTE who are being treated with therapeutic anticoagulation, routine placement of an IVC filter is not recommended.

In patients with acute PE who are receiving advanced therapies, consideration of IVC filter placement is suggested only in select patients.

In patients with DVT who are receiving advanced therapies, consideration of IVC filter placement is suggested only in select patients.

In trauma patients without known acute VTE, it is recommended that routine placement of IVC filters for primary VTE prophylaxis not be performed.

In patients without known acute VTE who are undergoing major surgery, it is suggested that routine placement of IVC filters not be performed.

In patients with indwelling IVC filters who have no other indication for anticoagulation, no recommendation can be made for or against anticoagulation.

In patients with indwelling retrievable/convertible IVC filters whose risk of PE has been mitigated or who are no longer at risk for PE, it is suggested that filters be routinely removed or converted unless risk outweighs benefit.

In patients with indwelling permanent IVC filters whose risk of PE has been mitigated or who are no longer at risk for PE, it is suggested that filter removal not be routinely performed.

In patients with complications attributed to indwelling IVC filters, consideration of filter removal is suggested after weighing of filter- versus procedure-related risks and assessment of the likelihood that filter removal will alleviate the complications.

In patients who have an IVC filter, the use of a structured follow-up program is recommended to increase retrieval rates and detect complications.

In patients in whom IVC filter removal is planned, routine preprocedural imaging of the filter and the use of laboratory studies are not suggested, except in select situations.

In patients undergoing filter retrieval whose filter could not be removed with standard techniques, attempted removal with advanced techniques is suggested if appropriate and if the expertise is available, after reevaluation of risks and benefits.

In patients undergoing IVC filter placement, no recommendation can be made for or against any specific placement technique.

For more information, please go to Inferior Vena Cava Filters, Venous Thromboembolism (VTE), Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE).

For more Clinical Practice Guidelines, please go to Guidelines.

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