The quality of evidence is downgraded by imprecise results (few outcome events).
A Cochrane review [Abstract] 1 included 6 studies with a total of 1 388 subjects. Meta-analysis was not possible due to clinical heterogeneity. Only 2 studies were considered to be relevant to current clinical settings.
One study (n=399) compared a retrievable inferior vena caval filter plus anticoagulation with anticoagulation alone in subjects at high risk of pulmonary embolism (PE). No differences were observed in the rates of PE, death, lower extremity deep vein thrombosis (DVT), or bleeding at 3 and 6 months after the intervention. A filter was inserted in 193 people, but could only be successfully retrieved from 153. Minor filter complications were noted at 6 months.
The second study (n=240) included subjects who had sustained multiple traumatic injuries, and compared a filter with no filter, 3 days after injury, in conjunction with anticoagulation and intermittent pneumatic compression. Prophylactic anticoagulation was initiated in both groups when it was thought safe to do so. There was no difference in symptomatic PE, death, or lower limb venous thrombosis rates. The only major filter complication was that one person required surgical removal of the filter as it could not be done percutaneously.
The remaining 4 studies were deemed not relevant to current clinical practice. One study showed an increased incidence of long-term lower extremity DVT at 8 years. Three studies were not clinically applicable because they utilised permanent filters which are seldom used now, or they did not use routine prophylactic anticoagulation which is current standard practice. The fourth study compared 2 filter types and was terminated prematurely as one filter group had a higher rate of thrombosis compared to the other filter type.
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