McMaster University, Hamilton, ON, Canada.
Health Research Methodology, McMaster University, Hamilton, ON, Canada.
J Thromb Thrombolysis. 2022 Oct;54(3):502-523. doi: 10.1007/s11239-022-02689-3. Epub 2022 Aug 12.
Prophylactic placement of inferior vena cava (IVC) filters prior to performing bariatric surgery is an intervention of unclear safety and efficacy with disagreement between current practice guidelines. To better characterize the risk and benefit of IVC filter insertion prior to bariatric surgery based on the current evidence. A systematic review of the literature of patients with prophylactic IVC filter insertion prior to bariatric surgery was performed and 32 studies were identified for inclusion into the review, of which none were randomized controlled trials. Meta-analysis was performed including the high-quality included studies. Seven high quality studies reported thrombotic events in patients undergoing bariatric surgery who had an IVCF and a control group which allowed for meta-analysis. The pooled odds ratio of venous thrombotic events in the IVC filter population versus the group without IVC filters was 1.57 (95%CI 0.89, 2.76). Among high quality studies 5 reported major bleeding with a rate of 0.76% and 6 reported on IVC filter complications with a rate of 0.67%. Overall no significant reduction in the rate of venous thrombosis was found with prophylactic IVC filter insertion. Use of IVC filters for prophylaxis remains a concern given the lack of clear efficacy in this setting and a small but present complication risk.
在进行减肥手术之前预防性放置下腔静脉（IVC）滤器是一种安全性和疗效尚不清楚的干预措施，目前的实践指南存在分歧。为了更好地根据现有证据描述减肥手术前放置 IVC 滤器的风险和益处。对减肥手术前预防性放置 IVC 滤器的患者进行了文献的系统评价，确定了 32 项研究纳入了该综述，其中没有随机对照试验。对包括高质量研究在内的研究进行了荟萃分析。7 项高质量研究报告了在接受减肥手术的患者中，IVCF 患者和对照组中存在血栓形成事件，允许进行荟萃分析。IVC 滤器组与无 IVC 滤器组静脉血栓形成事件的合并优势比为 1.57（95%CI 0.89, 2.76）。在高质量研究中，有 5 项研究报告了大出血的发生率为 0.76%，6 项研究报告了 IVC 滤器并发症的发生率为 0.67%。总体而言，预防性放置 IVC 滤器并没有显著降低静脉血栓形成的发生率。鉴于在这种情况下缺乏明确的疗效，以及存在较小但存在的并发症风险，使用 IVC 滤器进行预防仍然令人关注。
