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.
Fresh RCT on IVC filters! 240 trauma patients with initial contraindication to DVT prophylaxis randomized to IVC filter vs no filter. Primary endpoint was a composite of symptomatic PE or death. The first evident problem is *power*… (#rantorial, 1/7…)https://t.co/RzhkmnNTm2 pic.twitter.com/IaYlhHN8ZD
— josh farkas 💊 (@PulmCrit) July 9, 2019