Is it worth adding an inferior vena cava filter to anticoagulation in thromboembolic disease?

Medwave. 2017 Apr 28;17(Suppl2):e6935. doi: 10.5867/medwave.2017.6935.
[Article in Spanish, English]

Abstract

Some patients who have presented a thromboembolic event persist with a high risk of recurrence despite anticoagulant treatment. It has been suggested that adding an inferior vena cava filter may reduce this risk, but the clinical effects of this measure are not clear. To answer this question we searched in Epistemonikos database, which is maintained by screening multiple information sources. We identified three systematic reviews including four randomized trials answering this question. We extracted data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded there might be little or no difference on the occurrence of deep venous thrombosis by adding an inferior vena cava filter in anticoagulated patients, and it is not clear whether there are differences in the occurrence of pulmonary embolism or mortality because the certainty of evidence is very low.

A pesar del tratamiento anticoagulante, algunos pacientes que han presentado un episodio de enfermedad tromboembólica persisten con riesgo elevado de recurrencia. Se ha planteado que adicionar un filtro de vena cava inferior podría disminuir este riesgo, pero la real utilidad clínica no está clara. Para responder esta pregunta utilizamos la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples fuentes de información. Identificamos tres revisiones sistemáticas que en conjunto incluyen cuatro ensayos aleatorizados que responden la pregunta. Extrajimos los datos, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que podría existir poca o nula diferencia en cuanto a la ocurrencia de trombosis venosa profunda al agregar un filtro de vena cava inferior en pacientes anticoagulados, y que no está claro si existen diferencias en cuanto a la ocurrencia de tromboembolismo pulmonar o mortalidad porque la certeza de la evidencia es muy baja.

Publication types

  • Meta-Analysis

MeSH terms

  • Anticoagulants / administration & dosage*
  • Combined Modality Therapy
  • Databases, Factual
  • Humans
  • Pulmonary Embolism / prevention & control
  • Pulmonary Embolism / therapy
  • Randomized Controlled Trials as Topic
  • Secondary Prevention / methods
  • Thromboembolism / prevention & control
  • Thromboembolism / therapy*
  • Vena Cava Filters*
  • Vena Cava, Inferior
  • Venous Thrombosis / prevention & control
  • Venous Thrombosis / therapy

Substances

  • Anticoagulants