An estimated 200,000 pulmonary embolism (PE) deaths related to deep vein thrombosis (DVT) occur each year in the United States. For those at risk, the placement of an inferior vena cava (IVC) filter may be an effective solution to reducing DVT.
A DVT is a potentially dangerous and even life threatening condition. A deep vein thrombosis is a blood clot that most commonly forms in the legs and thighs. If such a clot were to break free from the blood vessel in which it formed, a pulmonary embolism would result. A pulmonary embolism blocks blood flow to the lungs and if large enough, could occlude blood flow in and around the heart itself.
An IVC filter is a device placed intraoperatively, most commonly into the femoral vein utilizing radiologic technology and contrast dyes. The placement of the filter along the femoral vein is determined by where the clot actually lies. Such a filter is designed to capture and hold blood clots that pass through the inferior vena cava. This ‘basketing’ prevents clots from traveling up to the heart and lungs. Over time captured clots emulsify as a result of enzymes in the blood stream.
Although an IVC filter has benefits, some recent studies are raising questions about their possible side effects as well as potential dangers to patients caused by the way doctors are using and removing the device after treatment.
In a study by the Journal of the American Medical Association Internal Medicine, five percent of more than 952 patients in the study with an IVC filter in place developed pulmonary embolism. Moreover, eight percent of patients still developed DVT even after the filter was inserted. Dangerous migration of the catheter itself causing vessel perforation and migration of blood clots already captured within the filter were also reported.
It was noted that many of the patients in this study did not have their filters successfully removed nor did they have optimal outcomes with the filter. Many of these patients could have started anticoagulant therapy as opposed to IVC filter placement. Another finding of the study is that over half of these patients received their IVC filter prophylactically without showing any actual signs of DVT.
The US Food and Drug Administration (FDA) issued a warning related to IVC filters. The FDA’s warning reminds doctors that IVC filters are intended for short term use and should be removed after the threat of pulmonary embolism is eliminated. Physician practices of leaving the retrievable filters in place and neglecting to administer anticoagulant drugs prompts researchers to further study the long-term effects of unretrieved removable filters which may cause unnecessary harm to patients.
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