Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
J Thromb Haemost. 2017 Jan;15(1):3-12. doi: 10.1111/jth.13564. Epub 2016 Dec 26.
Use of inferior vena cava (IVC) filters has increased dramatically in recent decades, despite a lack of evidence that their use has impacted venous thromboembolism (VTE)-related mortality. This increased use appears to be primarily driven by the insertion of retrievable filters for prophylactic indications. A growing body of evidence, however, suggests that IVC filters are frequently associated with clinically important adverse events, prompting a closer look at their role. We sought to narratively review the current evidence on the efficacy and safety of IVC filter placements. Inferior vena cava filters remain the only treatment option for patients with an acute (within 2-4 weeks) proximal deep vein thrombosis (DVT) or pulmonary embolism and an absolute contraindication to anticoagulation. In such patients, anticoagulation should be resumed and IVC filters removed as soon as the contraindication has passed. For all other indications, there is insufficient evidence to support the use of IVC filters and high-quality trials are required. In patients where an IVC filter remains, regular follow-up to reassess removal and screen for filter-related complications should occur.
近几十年来，下腔静脉（IVC）过滤器的使用显著增加，尽管缺乏证据表明其使用会影响静脉血栓栓塞（VTE）相关死亡率。这种使用的增加似乎主要是由于预防性放置可回收的过滤器所致。然而，越来越多的证据表明，IVC 过滤器经常与临床重要的不良事件相关，促使人们更仔细地研究其作用。我们旨在对 IVC 过滤器放置的疗效和安全性的现有证据进行叙述性回顾。IVC 过滤器仍然是急性（2-4 周内）近端深静脉血栓形成（DVT）或肺栓塞且抗凝绝对禁忌的患者的唯一治疗选择。在这些患者中，一旦禁忌解除，就应恢复抗凝并取出 IVC 过滤器。对于所有其他适应证，没有足够的证据支持使用 IVC 过滤器，需要进行高质量的试验。对于仍存在 IVC 过滤器的患者，应定期进行随访以重新评估取出和筛查与过滤器相关的并发症。
