Mismetti P, Rivron-Guillot K, Moulin N
Unité de recherche clinique, d'innovation et de pharmacologie EA 3065, CIE 3, service de médecine interne et thérapeutique et thérapeutique, CHU de Saint-Etienne, France.
Pathol Biol (Paris). 2008 Jun;56(4):229-32. doi: 10.1016/j.patbio.2008.03.002. Epub 2008 May 5.
Despite numerous publications, there is still only one randomised clinical trial with vena cava filter in the treatment of venous thromboembolism (VTE). This study has shown a potential and early benefit on the risk of pulmonary embolism (PE) (the first three months) but a late negative effect on the risk of deep vein thrombosis (DVT) recurrences (beyond the sixth month) especially on the risk of filter thrombosis. Consequently, the international recommendations are against a systematic use of vena cava filter to treat VTE (grade 1A) and they suggest to use them in case of a recurrence despite adequate treatment or in case of a contra-indication to anticoagulants (grade 2C). But these two conditions are frequent with VTE associated with cancer since, the risk of VTE recurrences is about 5 to 10% despite prolonged low-molecular-weight heparins (LMWH) treatment and the major bleeding risk is also about 5 to 10% in this case. These VTE recurrences are frequently early (first month of treatment) and contra-indications to anticoagulants due to major bleeding are mostly temporary. In this way, retrievable vena cava filters (possible retrieval until six months after placement) could be useful in order, to prevent recurrences during the thromboembolic risk period without any prolonged increasing risk of vena cava thrombosis. However, vena cava filters could be associated with some complications (tilt, migration sepsis...). So without any strong validation, they have still to be considered as a therapeutic strategy needing to be evaluated especially in cancer patient.
尽管有大量相关文献，但在静脉血栓栓塞症（VTE）治疗中使用腔静脉滤器的随机临床试验仍仅有一项。该研究显示，（在前三个月）对肺栓塞（PE）风险有潜在的早期益处，但对深静脉血栓形成（DVT）复发风险（六个月后）有后期负面影响，尤其是滤器血栓形成风险。因此，国际指南反对系统性使用腔静脉滤器治疗VTE（1A级），建议在充分治疗后仍复发或存在抗凝药物禁忌的情况下使用（2C级）。但这两种情况在癌症相关的VTE中很常见，因为尽管长期使用低分子肝素（LMWH）治疗，VTE复发风险仍约为5%至10%，且此时严重出血风险也约为5%至10%。这些VTE复发通常较早（治疗的第一个月），因严重出血导致的抗凝药物禁忌大多是暂时的。这样一来，可回收腔静脉滤器（放置后六个月内可回收）可能有用，以便在血栓栓塞风险期预防复发，而不会长期增加腔静脉血栓形成风险。然而，腔静脉滤器可能会引发一些并发症（倾斜、移位、感染等）。所以，在没有充分验证的情况下，它们仍应被视为一种需要评估的治疗策略，尤其是在癌症患者中。
