title: Use of a retrievable vena cava filter with low-intensity anticoagulation for prevention of pulmonary embolism in patients with cancer: an observational study in 106 cases.
abstract: OBJECTIVE
  To evaluate a retrievable inferior vena cava (IVC) filter in combination with low-intensity oral anticoagulation for prevention of pulmonary embolism (PE) in patients with malignancy complicated by thromboembolic disease.
  
  
  METHODS
  From October 2005 to December 2009, 107 Bard G2 filters were placed in 106 patients. Forty-eight patients had deep vein thrombosis (DVT) alone, 53 had PE with DVT, and five had PE with no evidence of DVT. After an initial period of anticoagulation with heparin, low-intensity oral anticoagulant therapy to achieve a target International Normalized Ratio of 1.5-2.0 was instituted. Follow-up computed tomography to evaluate the pulmonary circulation, IVC, and lower limbs was performed at 3 and 6 months.
  
  
  RESULTS
  PE recurred in three of 58 patients (5.2%). None of the 48 patients with DVT alone developed PE, nor was there any recurrence of DVT. The filter was removed in 14 patients (13.2%). No complications occurred during the retrieval procedure. A total of 16 complications occurred in seven patients: one migration (0.9%); four cases of vena cava thrombosis (3.7%), three of which were associated with recurrent PE (2.8%); one filter fracture (0.9%); and one IVC penetration (0.9%). Filter tilting greater than 15° occurred in six patients (5.7%) and was associated with other complications in five (4.7%).
  
  
  CONCLUSIONS
  In patients with malignancies complicated by venous thromboembolic disease, an IVC filter together with low-intensity anticoagulation may be a possible treatment strategy for PE prophylaxis. Controlled studies are warranted.
authors.affiliation: Department of Radiology and Diagnostic Imaging 2, Istituto Nazionale Tumori, Milan, Italy. bruno.damascelli@fastwebnet.it
authors.forename: Bruno
authors.initials: B
authors.lastname: Damascelli
authors.forename: Vladimira
authors.initials: V
authors.lastname: Ticha
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Patelli
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Lanocita
authors.forename: Carlo
authors.initials: C
authors.lastname: Morosi
authors.forename: Enrico
authors.initials: E
authors.lastname: Civelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tolla
authors.forename: Laura Francesca
authors.initials: LF
authors.lastname: Frigerio
authors.forename: Elisa
authors.initials: E
authors.lastname: Ciceri
authors.forename: Francesco
authors.initials: F
authors.lastname: Garbagnati
authors.forename: Carlo
authors.initials: C
authors.lastname: Spreafico
authors.forename: Paola
authors.initials: P
authors.lastname: Amadeo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Marchianò
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D003131:Combined Modality Therapy; D020878:Device Removal; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D007558:Italy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010690:Phlebography / Q000379:methods; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects; D020246:Venous Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants