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Blood, Vol. 95 No. 12 (June 15), 2000:
pp. 3669-3677
REVIEW ARTICLE
Vena caval filters: a comprehensive review
Michael B. Streiff
From the Division of Hematology, Department of Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD.
Hematologists are often asked to treat patients with venous
thromboembolic disease. Although anticoagulation remains the primary therapy for venous thromboembolism, vena caval filters are an important
alternative when anticoagulants are contraindicated. To assess the
evidence supporting the utility of these devices, a comprehensive
review of the English language literature was performed.
Except for one randomized trial, the vena caval filter literature
consists of case series or consecutive case series. The mean
duration of follow-up for each of the 5 filter types varies
from 6 to 18 months. All are about equally effective in the prevention
of pulmonary embolism (2.6%-3.8%). Deep venous thrombosis
(6%-32%) and inferior vena cava thrombosis (3.6%-11.2%) after
filter placement vary widely among different filter types primarily because of differences in outcome assessment.
Thrombosis at the insertion site is a common complication of filter
placement (23%-36%). In view of the absence of randomized
comparisons, no filter can be designated as superior in
safety or efficacy. Vena caval filters represent a potentially
important but poorly evaluated therapeutic modality in the prevention
of pulmonary emboli. Randomized trials are necessary to
establish the appropriate place for vena caval filters in the treatment
of venous thromboembolic disease.
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Related Letter in Blood Online:
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Reconsidering anticoagulant therapy in venous thromboembolism
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Blood 2002 99: 723-724.
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