Bottom line: Indications include patients with lower extremity DVT or PE when anticoagulation therapy not possible due to bleeding risk. When bleeding risk resolves, ACCP recommends traditional anticoagulation therapy.
Summary: DynaMed cites ACCP recommendations for antithrombotic therapy in venous thromboembolic disease (2008).
Section 1.13 includes discussion of IVC filters for initial treatment of DVT and
1. For patients with DVT, the guideline developers recommend against the routine use of a vena cava filter in addition to anticoagulants (Grade 1A).
2. For patients with acute proximal DVT, if anticoagulant therapy is not possible because of the risk of bleeding, the guideline developers recommend placement of an inferior vena cava filter (Grade 1C).
3. For patients with acute DVT who have an inferior vena cava (IVC) filter inserted as an alternative to anticoagulation, the guideline developers recommend that they should subsequently receive a conventional course of anticoagulant therapy if their risk of bleeding resolves (Grade 1C).
Guideline cites one RCT of routine use of filters in patients who are also anticoagulated (PREPIC study. Circulation 2005;112: 416-22. RESULTS: 1) IVC + anticoagulation is not more effective than anticoagulation alone for preventing recurrent VTE (RR, 1.34 at 2 years; and RR, 1.03 at 8 years) or total mortality (RR, 1.08 at 2 years; and RR, 0.95 at 8 years).