J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 10, October 2018, pages 758-764

Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature

**Table 1.** Society of Interventional Radiology Guidelines for Indications for Inferior Vena Cava Filters
DVT: deep venous thrombosis; PE: pulmonary embolism; VTE, venous thromboembolism.
Absolute indications
Recurrent VTE (acute or chronic) despite adequate anticoagulation
Contraindication to anticoagulation
Complication of anticoagulation
Inability to achieve/maintain therapeutic anticoagulation
Relative indications
Iliocaval DVT
Large, free-floating proximal DVT
Difficulty establishing therapeutic anticoagulation
Massive PE treated with thrombolysis/thrombectomy
Chronic PE treated with thromboendarterectomy
Thrombolysis for iliocaval DVT
VTE with limited cardiopulmonary reserve
Recurrent PE with filter in place
Poor compliance with anticoagulant medications
High risk of complication of anticoagulation (e.g. ataxia, frequent falls)
Prophylactic indications
Trauma patient with high risk of VTE
Surgical procedure in patient at high risk of VTE
Medical condition with high risk of VTE

Table 1. Society of Interventional Radiology Guidelines for Indications for Inferior Vena Cava Filters

DVT: deep venous thrombosis; PE: pulmonary embolism; VTE, venous thromboembolism.

Absolute indications

Recurrent VTE (acute or chronic) despite adequate anticoagulation

Contraindication to anticoagulation

Complication of anticoagulation

Inability to achieve/maintain therapeutic anticoagulation

Relative indications

Iliocaval DVT

Large, free-floating proximal DVT

Difficulty establishing therapeutic anticoagulation

Massive PE treated with thrombolysis/thrombectomy

Chronic PE treated with thromboendarterectomy

Thrombolysis for iliocaval DVT

VTE with limited cardiopulmonary reserve

Recurrent PE with filter in place

Poor compliance with anticoagulant medications

High risk of complication of anticoagulation (e.g. ataxia, frequent falls)

Prophylactic indications

Trauma patient with high risk of VTE

Surgical procedure in patient at high risk of VTE

Medical condition with high risk of VTE

**Table 2.** American College of Chest Physician Guidelines for Indications for Inferior Vena Cava Filters
For the initial treatment of patients with acute proximal DVT or PE, if anticoagulant therapy is not possible because of the risk of bleeding, placement of an IVCF is recommended (grade 1C)
For patients with chronic thromboembolic pulmonary hypertension (CTPH) undergoing pulmonary thromboendarterectomy, placement of a permanent vena caval filter before or at the time of the procedure is suggested (grade 2C)

Table 2. American College of Chest Physician Guidelines for Indications for Inferior Vena Cava Filters

For the initial treatment of patients with acute proximal DVT or PE, if anticoagulant therapy is not possible because of the risk of bleeding, placement of an IVCF is recommended (grade 1C)

For patients with chronic thromboembolic pulmonary hypertension (CTPH) undergoing pulmonary thromboendarterectomy, placement of a permanent vena caval filter before or at the time of the procedure is suggested (grade 2C)

**Table 3.** Referring Services Requesting IVCF Placement
Referring services
General medicine	23
Neurology/neurology intensive care unit/stroke	16
Oncology	10
Malignant hematology	9
Medical intensive care unit	5
Gastroenterology	3
Cardiology	1
Primary care	1
Total	68 (37.8%)
Gynecology oncology	37
Neurosurgery	18
Trauma surgery	10
General/acute surgery	8
Gastroenterology surgery	7
Orthopedics	6
Surgical oncology	6
Renal transplant	4
Urology	4
Surgical intensive care unit	4
Ear, nose and throat	2
Vascular surgery	2
Cardiothoracic surgery	1
Heart transplant	1
Obstetrics	1
Thoracic surgery	1
Total	112 (62.2%)

Table 3. Referring Services Requesting IVCF Placement

Referring services

Medical services

General medicine

Neurology/neurology intensive care unit/stroke

Oncology

Malignant hematology

Medical intensive care unit

Gastroenterology

Cardiology

Primary care

Total

68 (37.8%)

Surgical services

Gynecology oncology

Neurosurgery

Trauma surgery

General/acute surgery

Gastroenterology surgery

Orthopedics

Surgical oncology

Renal transplant

Urology

Surgical intensive care unit

Ear, nose and throat

Vascular surgery

Cardiothoracic surgery

Heart transplant

Obstetrics

Thoracic surgery

Total

112 (62.2%)

**Table 4.** Detailed Analysis of Permanent IVCF Placement
Permanent IVCF placement	n = 26	%
IVCF: inferior vena cava filter; AC: anticoagulation; VTE: venous thromboembolism.
Mean age (years)	71.1
Range (years)	54 - 85
Presence of cancer	19	73.1
Indication for placement
Contraindication to AC	19
Bleeding	13
Intracranial hemorrhage	2
Surgery	3
Thrombocytopenia	1
Recurrent VTE despite adequate AC	3
High risk of complication of AC	1
Prophylaxis - history of VTE	2
None	1
Died inpatient	3
Discharge to home hospice	2
Of the remaining 21 patients
Restarted AC prior to discharge	8	38.1

Table 4. Detailed Analysis of Permanent IVCF Placement

Permanent IVCF placement

n = 26

IVCF: inferior vena cava filter; AC: anticoagulation; VTE: venous thromboembolism.

Mean age (years)

71.1

Range (years)

54 - 85

Presence of cancer

73.1

Indication for placement

Contraindication to AC

Bleeding

Intracranial hemorrhage

Surgery

Thrombocytopenia

Recurrent VTE despite adequate AC

High risk of complication of AC

Prophylaxis - history of VTE

None

Died inpatient

Discharge to home hospice

Of the remaining 21 patients

Restarted AC prior to discharge

38.1

**Table 5.** Detailed Analysis of Retrieval IVCF Placement
Retrievable IVCF placement	n = 154	%
IVCF: inferior vena cava filter; AC: anticoagulation; VTE: venous thromboembolism; CV: cardiovascular; DVT: deep vein thrombosis; PE: pulmonary embolism; LTAC: long-term acute care; SNF: skilled nursing facility.
Mean age (years)	57.3
Range (years)	19 - 84
Presence of cancer	76	49.4
Indication for placement
Contraindication to AC	84
Bleeding	39
Intracranial hemorrhage	16
Surgery	24
Thrombocytopenia	5
Recurrent VTE despite adequate AC	2
Inability to maintain AC	1
High risk of complication of AC	15
VTE with limited CV reserve	2
Thrombectomy for DVT	3
Thrombolysis for PE	4
Iliac caval or free floating DVT	2
Prophylaxis - no history of VTE	8
Prophylaxis - history of VTE	16
None	17
Discharge locations
Died inpatient	11
Home hospice	11
Acute care hospital/LTAC	14
Rehab unit/SNF/nursing home	37
Home	80
Acute psychiatric unit	1

Table 5. Detailed Analysis of Retrieval IVCF Placement

Retrievable IVCF placement

n = 154

IVCF: inferior vena cava filter; AC: anticoagulation; VTE: venous thromboembolism; CV: cardiovascular; DVT: deep vein thrombosis; PE: pulmonary embolism; LTAC: long-term acute care; SNF: skilled nursing facility.

Mean age (years)

57.3

Range (years)

19 - 84

Presence of cancer

49.4

Indication for placement

Contraindication to AC

Bleeding

Intracranial hemorrhage

Surgery

Thrombocytopenia

Recurrent VTE despite adequate AC

Inability to maintain AC

High risk of complication of AC

VTE with limited CV reserve

Thrombectomy for DVT

Thrombolysis for PE

Iliac caval or free floating DVT

Prophylaxis - no history of VTE

Prophylaxis - history of VTE

None

Discharge locations

Died inpatient

Home hospice

Acute care hospital/LTAC

Rehab unit/SNF/nursing home

Home

Acute psychiatric unit

**Table 6.** Odds Ratio for Predictors of IVCF Retrieval
Variable	OR	95% CI	P value
Prior hematology consultation	3.96	0.92 - 1.69	0.0635
Surgical services (compared with medical services)	2.43	0.91 - 6.50	0.0758
Outlined instructions on discharge summary	2.41	0.85 - 6.85	0.0991
Discharge to home (compared to non-home locations)	2.12	0.81 - 5.51	0.1222

Table 6. Odds Ratio for Predictors of IVCF Retrieval

Variable

95% CI

P value

Prior hematology consultation

3.96

0.92 - 1.69

0.0635

Surgical services (compared with medical services)

2.43

0.91 - 6.50

0.0758

Outlined instructions on discharge summary

2.41

0.85 - 6.85

0.0991

Discharge to home (compared to non-home locations)

2.12

0.81 - 5.51

0.1222