Vena caval filter use in patients with sepsis: results in 175 patients.
BACKGROUND
Septic patients are at risk of thromboembolism. However, the Food and Drug Administration guidance for intravascular filters states that "filters should not be implanted in patients with risk of septic embolism." The purpose of this study is to evaluate this restriction.


OBJECTIVE
There is no difference in outcomes following filter placement in patients with and without septicemia.


METHODS
A registry of vena caval filter experiences containing information regarding filter placement and annual examinations of more than 2600 patients obtained during a 15-year period was reviewed. We conducted a MEDLINE search of publications reporting clinical sequelae of filter placement in septic patients.


METHODS
The registry was searched for patients with a diagnosis of sepsis at filter placement; survival rates, adverse events, and recurrent sepsis or thromboembolism were noted. The MEDLINE search joined results from 7 MeSH headings (vena cava filter,sepsis, septic thromboembolism, vena caval filter contraindication, and filter adverse events) related to filters and sepsis.


RESULTS
One-hundred seventy-five patients (6.7%) met the criteria and received Greenfield filters. None of the adverse events were related to sepsis, and no filter was removed. Follow-up data were available for 56 patients, with a combined recurrent pulmonary embolism and caval occlusion rate of 1.7%. The 30-day mortality rate was 33%. We noted a significant difference in survival related to the use of anticoagulation therapy (P =.001) and to age (P =.004). The MEDLINE search did not identify any clinical reports of septic filters or the need to remove a filter because of sepsis.


CONCLUSIONS
Based on our review, the Greenfield filter is a safe method of prophylaxis for septic patients. Rescinding the restriction for use of vena caval filters in septic patients should be considered by regulatory bodies.
Greenfield
Lazar J
LJ
Department of Surgery, University of Michigan, Ann Arbor, USA.
Proctor
Mary C
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004617:Embolism / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D018805:Sepsis / Q000150:complications / Q000601:surgery*; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D016306:Vena Cava Filters