Pulmonary embolism IVC filter
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]
Overview
2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis (DO NOT EDIT)[1]
Recommendations for Initial Treatment of Acute PE
Class I | "1. In patients with acute PE who are treated with anticoagulants, we recommend against the use of an IVC filter. (Level of Evidence: B)" |
"2. In patients with acute PE and contraindication to anticoagulation, we recommend the use of an IVC filter. (Level of Evidence: B)" |
Class IIa |
"1. In patients with acute PE and an IVC filter inserted as an alternative to anticoagulation, we suggest a conventional course of anticoagulant therapy if their risk of bleeding resolves. (Level of Evidence: B)" |
2011 AHA Scientific Statement- Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)[2]
Recommendations on IVC Filters in the Setting of Acute PE (DO NOT EDIT)[2]
Class I |
"1. Adult patients with any confirmed acute PE (or proximal DVT) with contraindications to anticoagulation or with active bleeding complication should receive an IVC filter. (Level of Evidence: C) " |
"2. Anticoagulation should be resumed in patients with an IVC filter once contraindications to anticoagulation or active bleeding complications have resolved. (Level of Evidence: B) " |
"3. Patients who receive retrievable IVC filters should be evaluated periodically for filter retrieval within the specific filter's retrieval window. (Level of Evidence: C)" |
Class III (No Benefit) |
"1. An IVC filter should not be used routinely as an adjuvant to anticoagulation and systemic fibrinolysis in the treatment of acute PE. (Level of Evidence: C). " |
Class IIa |
"1. For patients with recurrent acute PE despite therapeutic anticoagulation, it is reasonable to place an IVC filter (Level of Evidence: C)" |
"2. For DVT or PE patients who will require permanent IVC filtration (eg, those with a long-term contraindication to anticoagulation), it is reasonable to select a permanent IVC filter device. (Level of Evidence: C)." |
"3. For DVT or PE patients with a time-limited indication for an IVC filter (eg, those with a short-term contraindication to anticoagulation therapy), it is reasonable to select a retrievable IVC filter device. (Level of Evidence: C)." |
Class IIb |
"1. Placement of an IVC filter may be considered for patients with acute PE and very poor cardiopulmonary reserve, including those with massive PE. (Level of Evidence: C)." |
References
- ↑ Kearon C, Akl EA, Comerota AJ; et al. (2012). "Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e419S–94S. doi:10.1378/chest.11-2301. PMID 22315268. Unknown parameter
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ignored (help) - ↑ 2.0 2.1 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.