Suggestions for the safe use of VCFs
| Each hospital or health network should have a written VCF guideline and policy that includes, at a minimum, standardized indications, monitoring, and postinsertion practices (lines of responsibility, follow-up). |
| A single group of physicians (eg, interventional radiology, hematology, thromboembolism, or hospital medicine) should accept responsibility for standardized patient selection, monitoring, and follow-up based on the organization’s written policy. |
| VCF placement should generally be limited to patients with recent proximal DVT and an absolute contraindication for anticoagulation. |
| Only retrievable filters should be used; there are very few patients with acute VTE who have a long-term contraindication to anticoagulation. |
| At the time of insertion, patients should receive written information about the purpose of VCFs, alternatives to filter use, major and common risks, and planned management after insertion. |
| A well-defined, systematic monitoring and follow-up plan that includes a plan for retrieval should be implemented for each patient at the time of filter insertion. |
| Anticoagulation should be initiated to prevent extension of the DVT as soon as it is safe to do so (once the contraindication to anticoagulation has resolved, usually within a few days). Depending on the bleeding risk at that time, therapeutic anticoagulation may be possible in some patients. In others, starting with a prophylactic dose and gradually increasing to a therapeutic dose may be prudent. |
| VCF retrieval should be attempted in all patients who no longer have an indication for its use unless the goals of care suggest this is not warranted. The vast majority of VCFs should be removed shortly after the patient has been appropriately anticoagulated. Whenever possible, this should take place during the same admission as the filter insertion. |
| For VCFs that cannot be removed locally, consideration should be given to referral to a regional center with expertise in advanced retrieval techniques. |
| The duration of anticoagulation in patients with (or without) a VCF depends on well-established prognostic factors, including whether the VTE was provoked or unprovoked and sex.2 For patients with VCFs that are not removed, the need for long-term anticoagulation to prevent filter-induced caval thrombosis is unproven and controversial.1 ,2 Patients with VTE should receive anticoagulation appropriate to the VTE situation that prompted filter insertion, but we do not believe that the presence of a VCF alone warrants anticoagulation if anticoagulation is no longer required for their VTE. |
| For filters that are not retrieved, scheduled periodic assessment for consideration of delayed removal or, if removal is not possible, periodic assessment of filter integrity and complications should take place. The frequency and modality of imaging have not been resolved, but our practice is to obtain a plain abdominal X-ray once a year only for several years if there has been no visible change in the filter integrity. |
| VCF patients should be included in a local, searchable, electronic database. |
| Each hospital or health network should have a written VCF guideline and policy that includes, at a minimum, standardized indications, monitoring, and postinsertion practices (lines of responsibility, follow-up). |
| A single group of physicians (eg, interventional radiology, hematology, thromboembolism, or hospital medicine) should accept responsibility for standardized patient selection, monitoring, and follow-up based on the organization’s written policy. |
| VCF placement should generally be limited to patients with recent proximal DVT and an absolute contraindication for anticoagulation. |
| Only retrievable filters should be used; there are very few patients with acute VTE who have a long-term contraindication to anticoagulation. |
| At the time of insertion, patients should receive written information about the purpose of VCFs, alternatives to filter use, major and common risks, and planned management after insertion. |
| A well-defined, systematic monitoring and follow-up plan that includes a plan for retrieval should be implemented for each patient at the time of filter insertion. |
| Anticoagulation should be initiated to prevent extension of the DVT as soon as it is safe to do so (once the contraindication to anticoagulation has resolved, usually within a few days). Depending on the bleeding risk at that time, therapeutic anticoagulation may be possible in some patients. In others, starting with a prophylactic dose and gradually increasing to a therapeutic dose may be prudent. |
| VCF retrieval should be attempted in all patients who no longer have an indication for its use unless the goals of care suggest this is not warranted. The vast majority of VCFs should be removed shortly after the patient has been appropriately anticoagulated. Whenever possible, this should take place during the same admission as the filter insertion. |
| For VCFs that cannot be removed locally, consideration should be given to referral to a regional center with expertise in advanced retrieval techniques. |
| The duration of anticoagulation in patients with (or without) a VCF depends on well-established prognostic factors, including whether the VTE was provoked or unprovoked and sex.2 For patients with VCFs that are not removed, the need for long-term anticoagulation to prevent filter-induced caval thrombosis is unproven and controversial.1 ,2 Patients with VTE should receive anticoagulation appropriate to the VTE situation that prompted filter insertion, but we do not believe that the presence of a VCF alone warrants anticoagulation if anticoagulation is no longer required for their VTE. |
| For filters that are not retrieved, scheduled periodic assessment for consideration of delayed removal or, if removal is not possible, periodic assessment of filter integrity and complications should take place. The frequency and modality of imaging have not been resolved, but our practice is to obtain a plain abdominal X-ray once a year only for several years if there has been no visible change in the filter integrity. |
| VCF patients should be included in a local, searchable, electronic database. |