Researchers have discovered that few adverse events may be associated with the use of inferior vena cava filters to help prevent deep vein thrombosis from developing into pulmonary embolisms, according to a new study jointly published by Johnson et al in the Journal of Vascular and Interventional Radiology and the Journal of Vascular Surgery: Venous and Lymphatic Disorders.
Background
“[Deep vein thrombosis] and [pulmonary embolisms] are significant causes of death worldwide, and understanding fully how tools like [inferior vena cava] filters can be used to prevent the progression of a [deep vein thrombosis] into a [pulmonary embolism] allows physicians to safely treat patients at risk of death from [venous thromboembolisms],” explained senior study author David L. Gillespie, MD, RVT, FACS, DMCC, Chief of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center.
Study Methods and Results
In the multicenter, prospective, open-label, nonrandomized Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial, the researchers analyzed the safety and efficacy of inferior vena cava filters in 1,421 patients—1,019 of whom had an existing deep vein thrombosis or pulmonary embolism.
After their analysis, the researchers found that inferior vena cava filters may have effectively helped prevent pulmonary embolisms in patients experiencing a deep vein thrombosis who did not respond to treatment with anticoagulation medications or were not able to take the drugs. Approximately 50% of the patients in the study had their filters removed within 3 months of placement without experiencing complications or recurrence of their deep vein thrombosis or pulmonary embolisms.
“The question shouldn’t be only ‘[do] we place a filter?’ but ‘how should we offer comprehensive filter-inclusive care [to] patients with venous [thromboembolisms]—comprised of a detailed patient evaluation, a plan for retrieval after placement, and frequent follow-up with evaluation for filter removal or replacement?’” proposed lead study author Matthew S. Johnson, MD, FSIR, the Gary J. Becker Professor of Radiology Research and Professor of Surgery in the Department of Radiology and Imaging Sciences at the Indiana University School of Medicine. “[The] PRESERVE [trial] showed what questions we should ask as clinicians: ‘does this [patient] continue to require protection against [pulmonary embolisms]?’ and, in light of changing clinical status and available therapies, ‘is the current filter needed?’—and then make an informed decision on how to continue care,” he added.
“Now that the study is complete, we now have a roadmap for better [inferior vena cava] filter utilization. We need to solidify a clearer set of practice guidelines for venous [thromboembolism] based on its symptoms, location, and complications. Further studies will focus on how the different manifestations of venous [thromboembolism] may benefit from filter-inclusive care,” highlighted Dr. Gillespie.
Conclusions
“This trial represents an important step in collaborating across specialties to benefit the health and safety of our patients,” emphasized Parag J. Patel, MD, MS, FSIR, Professor of Radiology at the Medical College of Wisconsin and President of the Society of Interventional Radiology. “Thanks to the work of Dr. Johnson, [Dr.] Gillespie, and all the investigators and patients involved in the trial, we now have higher quality evidence to support appropriate utilization and management of [inferior vena cava] filters in patients with venous [thromboembolisms], he underscored.
The researchers concluded that with the implantation of the inferior vena cava filters demonstrating low adverse events and a low incidence of clinically significant pulmonary embolisms, the treatment may be safe and effective for patients with venous thromboembolisms.
Disclosures: For full disclosures of the study authors, visit jvir.org and jvsvenous.org.
