Efficacy and safety of cava filters in patients with an extremely high risk of venous thromboembolic complications

Introduction. In clinical practice, there are special situations when adequate anticoagulant therapy cannot be prescribed or does not prevent recurrence of PE. In such cases, the implantation of a cava filter seems to be the optimal treatment strategy, but the clinical efficacy and range of possible side effects of these devices remain unclear.

Aim. To evaluate the effectiveness and safety of implantation of cava filters into the inferior vena cava for the prevention of PE.

Materials and methods. The study included 530 patients with deep vein thrombosis of the lower extremities and an extremely high risk of PE in the period from 2008 to 2024. The CVF group consisted of 278 patients who had a cava filter implanted in the inferior vena cava, and the non-CVF group consisted of 252 patients who refused CVF implantation but had indications for its implantation. The primary endpoints of the study were death from any cause, confirmed PE with clinical manifestations, large or moderate bleeding, and the development of inferior vena cava syndrome. The secondary point in the CVF group was an embolism in the cava filter according to ultrasound examination.

Results. There were no significant differences between the groups in terms of clinical and demographic indicators, primary endpoints. The frequency of detection of thrombotic masses in the cava filter at the hospital stage was 23 cases (8.27%).

Discussion. When analyzing the Recommendations, CVF implantation in NSAIDs is recommended to be considered in special cases, however, according to the instructions of the ACCP, AHA and BSH, there are no indications for CVF implantation in all patients with DVT and/or PE who may be prescribed anticoagulant therapy.

Conclusion. Any implantation of a cava filter, as a potentially unsafe device, should be carried out only after the decision of a multidisciplinary consultation.

1. Orudzheva SA, Mitish VA, Ushakov AA, Magomedova SD, Blatun LA, Pashkalova YuS. Complications of deep vein thrombosis: pulmonary thromboembolism and venous gangrene of the lower extremities (clinical case). Wounds and Wound Infections. The prof. B.M. Kostyuchenok Journal. 2019;6(2):44–59. (In Russ.) https://doi.org/10.25199/2408-9613-2019-6-2-44-59.

2. Young T, Sriram KB. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev. 2020;10(10):CD006212. https://doi.org/10.1002/14651858.CD006212.pub5.

3. Seliverstov EI, Lobastov KV, Ilyukhin EA, Aphanova TV, Ahmetzyanov RV, Ahtyamov IF et al. Prevention, Diagnostics and Treatment of Deep Vein Thrombosis. Russian Experts Consensus. Flebologiya. 2023;17(3):152–296. (In Russ.) https://doi.org/10.17116/flebo202317031152.

4. Bokeria LA, Zatevakhin II, Kirienko AI. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEO). Flebologiya. 2015;9(4-2):4–52. (In Russ.) Available at: https://phlebolog.narod.ru/books/vteo2015.pdf.

5. Panchenko EP, Balahonova TV, Danilov NM, Komarov AL, Kropachyova ES, Saidova MA et al. Diagnosis and management of pulmonary embolism Eurasian association of cardiology (EAC) clinical practice guidelines (2021). Eurasian Heart Journal. 2021;(1):44–77. (In Russ.) https://doi.org/10.38109/2225-1685-2021-1-44-77.

6. Sоmonova OV, Antukh EA, Vardanyan AV, Gromova EG, Dolgushin BI, Elizarova AL et al. Practical recommendations for the prevention and treatment of thromboembolic complications in cancer patients. Malignant Tumors. 2021;11(3s2-2):145–155. https://doi.org/10.18027/2224-5057-2021-11-3s2-47.

7. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603. (In Russ.) https://doi.org/10.1093/eurheartj/ehz405.

8. Prozorov SA. Inferior vena cava suprarenal filter implantation. Journal of Radiology and Nuclear Medicine. 2017;98(1):50–53. (In Russ.) https://doi.org/10.20862/0042-4676-2017-98-1-50-53.

9. Kalva SP, Chkapoutaki C, Wicky S, Greenfield A, Waltman A, Athanasoulis Ch. Suprarenal inferior vena cava filters: a 20-year single-center experience. J Vasc Interv Radiol. 2008;19(7):1041–1047. https://doi.org/10.1016/j.jvir.2008.03.026.

10. Carrafiello G, Mangini M, Fontana F, Ierardi A, Massa A, Xhera G et al. Suprarenal inferior vena cava filter implantation. Radiol Med. 2012;117(7):1190–1198. https://doi.org/10.1007/s11547-012-0851-5.

11. Fang AS, Morita S, Gill GS, Kitanosono T, Mathes E, Lee D et al. Clinical outcomes of inferior vena cava filter placement in patients with renal vein anomalies. Ann Vasc Surg. 2014;28(2):318–323. https://doi.org/10.1016/j.avsg.2013.01.026.

12. Prozorov SA. Implantation of superior vena cava filters. Sklifosovsky Journal Emergency Medical Care. 2018;7(1):53–56. (In Russ.) https://doi.org/10.23934/2223-9022-2018-7-1-53-56.

13. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med. 1998;338(7):409–415. https://doi.org/10.1056/NEJM199802123380701.

14. Mismetti P, Quéré I, Schmidt J, Barral F, Couturaud F, Elias A. Prevention of pulmonary embolism recurrences by retrievable vena cava filter: results of the randomized multicenter trial PREPIC 2. J Thromb Haemost. 2013;11(2):28. Available at: https://www.researchgate.net/publication/291046278_Prevention_of_pulmonary_embolism_recurrences_by_retrievable_vena_cava_filter_results_of_the_randomized_multicenter_PREPIC_2_trial.

15. Ho KM, Rao S, Honeybul S, Zellweger R, Wibrow B, Lipman J et al. A multicenter trial of vena cava filters in severely injured patients. N Engl J Med. 2019;381(4):328–337. https://doi.org/10.1056/NEJMoa1806515.

16. Barginear MF, Gralla RJ, Bradley TP, Ali SS, Shapira I, Greben C et al. Investigating the benefit of adding a vena cava filter to anticoagulation with fondaparinux in patients with cancer and venous thromboembolism in a prospective randomized clinical trial. Support Care Cancer. 2012;20(11):2865–2872. https://doi.org/10.1007/s00520-012-1413-z.

17. Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of anti-hemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692–694. https://doi.org/10.1111/j.1538-7836.2005.01204.x.

18. Fullen WD, Miller EH, Steele WF, McDonough JJ. Prophylactic vena caval interruption in hip fractures. J Trauma. 1973;13(5):403–410. https://doi.org/10.1097/00005373-197305000-00001.

19. Bikdeli B, Chatterjee S, Desai NR, Kirtane AJ, Desai MM, Bracken MB et al. Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis. J Am Coll Cardiol. 2017;70(13):1587–1597. https://doi.org/10.1016/j.jacc.2017.07.775.

20. Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug K, Gerrsing G et al. Antithrombotic therapy for VTE disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):е545–е608. https://doi.org/10.1016/j.chest.2021.07.055.

21. Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693–4738. https://doi.org/10.1182/bloodadvances.2020001830.

22. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788–1830. https://doi.org/10.1161/CIR.0b013e318214914f.

23. Kaufman JA, Barnes GD, Chaer RA, Cuschieri J, Eberhaerdt R, Johnson MS et al. Society of Interventional Radiology Clinical Practice Guidline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease. J Vasc Interv Radiol. 2020;31(10):1529–1544. https://doi.org/10.1016/j.jvir.2020.06.014.

24. British Committee for Standards in Haematology Writing Group. Guidelines on use of vena cava filters. Br J Haematol. 2006;134(6):590–595. https://doi.org/10.1111/j/1365-2141.2006.06226.x.

25. Eastern Assocation for the Surgery of Trauma. Practice Management Guidelines. Venous Thromboembolism: Role of Vena Cava Filter in the Prophylaxis and Treatment of PE. J Trauma. 2002;53(1):142–164.

26. Kakkos SK, Gohel M, Baekgaard R, Bauersachs R, Bellmunt-Montoya S, Black SA et al. European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. https://doi.org/10.1016/j.ejvs.2020.09.023.