PREPIC-1 (Decousus et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis. NEJM 1998; 338:409)
PREPIC-1 Follow-Up Study (Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism. Circulation 2005; 112: 416-422)
PREPIC-2 (Effect of a retrievable inferior vena cava filter plus anticoagulation vs. anticoagulation alone on risk of recurrent pulmonary embolism: A randomized clinical trial. JAMA 2015; 313: 1627)
- For patients receiving anticoagulation, IVC filters do not improve mortality and may increase the risk of DVT and filter-related complications (e.g. filter thrombosis, migration, or fracture).
- It is unclear whether IVC filters reduce the risk of new PE. PREPIC-1 and PREPIC-2 both suggest that there is little or no short-term reduction (e.g. within 6-24 months). Long-term follow-up of the cohort from PREPIC-1 found a reduced risk of new PE at eight years, but this could have been subject to some bias.
- Currently evidence and guidelines from the American College of Chest Physicians both suggest that there is no role for IVC filters among patients who can receive anticoagulation.
Update (7/9/18) – A new study was just released regarding the use of IVC filters in trauma patients. Some key points regarding that study are covered in the below rantorial. Overall I don't think this study really changes things much – we continue to have no persuasive RCT evidence that IVC filters are beneficial.