title: Guidelines and the use of inferior vena cava filters: a review of an institutional experience.
abstract: OBJECTIVE
  Based on the American College of Chest Physicians 2004 antithrombotic therapy for venous thromboembolism (VTE) and the Eastern Association for the Surgery of Trauma 2002 guidelines, placement of an inferior vena cava (IVC) filter is indicated in patients who either have, or are at high risk for, VTE, but have a contraindication or failure of anticoagulation. Our aim is to compare clinical characteristics and outcomes of patients receiving IVC filters within-guidelines (WG) and outside-of-guidelines (OOG).
  
  
  METHODS
  The 558 patients who received an IVC filter were divided into two groups called WG or OOG. The WG group met the criteria described above and the OOG group did not have a contraindication to or a failure of anticoagulation.
  
  
  RESULTS
  The WG group had 362 patients and the OOG group had 196 patients. The OOG group had one (0.5%) patient with post-filter pulmonary embolism (PE), two (1%) with IVC thrombosis, and seven (3.6%) with deep vein thrombosis (DVT). The WG group had five (1.4%) patients with post-filter PE, 13 (3.6%) with IVC thrombosis, and 34 (9.4%) with DVT. All patients who developed post-filter PE had a DVT before filter placement, and patients who did not have a prior VTE event were at a significantly lower risk of developing post-filter IVC thrombosis and PE.
  
  
  CONCLUSIONS
  Our data do not support the use of an IVC filter outside of guidelines in patients without prior VTE who can tolerate anticoagulation because of the low risk of developing PE.
authors.affiliation: Department of Medicine, New York Medical College, Valhalla, NY 10595, USA.
authors.forename: P
authors.initials: P
authors.lastname: Singh
authors.forename: H M
authors.initials: HM
authors.lastname: Lai
authors.forename: R G
authors.initials: RG
authors.lastname: Lerner
authors.forename: T
authors.initials: T
authors.lastname: Chugh
authors.forename: W S
authors.initials: WS
authors.lastname: Aronow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D011655:Pulmonary Embolism / Q000517:prevention & control*; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000150:complications; D055815:Young Adult
chemical_list: D000925:Anticoagulants