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Edward J. Arous, MD; Louis M. Messina, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aDivision of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA

bDiabetes Center of Excellence, University of Massachusetts Medical School, Worcester, MA

CORRESPONDENCE TO: Louis M. Messina, MD, 55 Lake Ave N, Worcester, MA 01655


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):980-981. doi:10.1016/j.chest.2016.08.1434
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In response to our commentary “Temporary inferior vena cava filters: how do we move forward?” in CHEST, we received a letter from Dr Hoffer expressing concern regarding the recommendation for retrieval of inferior vena cava (IVC) filters in select high-risk patients. In our original publication, we cited the decision analysis work by Morales et al, for a goal retrieval of IVC filters 29 to 54 days postimplantation in patients at transient risk of pulmonary embolism (PE). Furthermore, in 2010 the US Food and Drug Administration (FDA) recommended that in “patients with retrievable IVC filters consider removing the filter as soon as protection from PE is no longer needed.” A subsequent update in 2014 encouraged all physicians to “consider the risks and benefits of filter removal for each patient. A patient should be referred for IVC filter removal when the risk/benefit profile favors removal and the procedure is feasible given the patient’s health status.”

It is of the utmost importance to differentiate between high-risk and low-risk populations. The published data regarding long-term filter complication rates is independent of the indication for its insertion. In addition, permanent filters have been shown to have a lower rate of complications than do retrievable filters, and it may be advantageous to insert permanent filters in patients at high risk for VTE, who are unlikely to tolerate therapeutic anticoagulation.

Our summary recommended the judicious use of temporary filters in select patients without VTE. We agree with Dr Hoffer that these patients have the lowest risk of VTE after filter retrieval and, therefore, would benefit the most from filter retrieval. In patients with VTE, we agree with the FDA recommendation to retrieve temporary IVC filters as soon as the risk of anticoagulation has passed and therapeutic dosing can be resumed. Last, a permanent IVC filter may be the best option for patients who are never expected to tolerate therapeutic anticoagulation, and are believed to be at highest risk for recurrent VTE.

References

Arous E.J. .Messina L.M. . Temporary inferior vena cava filters: how do we move forward? Chest. 2016;149:1143-1145 [PubMed]journal. [CrossRef] [PubMed]
 
Morales J.P. .Li X. .Irony T.Z. .Ibrahim N.G. .Moynahan M. .Cavanaugh K.J. Jr.. Decision analysis of retrievable inferior vena cava filters in patients without pulmonary embolism. J Vasc Surg Venous Lymphat Disord. 2013;1:376-384 [PubMed]journal. [CrossRef] [PubMed]
 
U.S. Food and Drug Administration. Removing retrievable inferior vena cava filters: initial communication.http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm. Issued August 9, 2010; last updated May 11, 2015. Accessed August 26, 2016.
 
U.S. Food and Drug Administration. Removing Retrievable inferior vena cava filters: FDA safety communication.http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm. Issued August 9, 2010; last updated May 6, 2014. Accessed July 31, 2016.
 
Andreoli J.M. .Lewandowski R.J. .Vogelzang R.L. .Ryu R.K. . Comparison of complication rates associated with permanent and retrievable inferior vena cava filters: a review of the MAUDE database. J Vasc Interv Radiol. 2014;25:1181-1185 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Arous E.J. .Messina L.M. . Temporary inferior vena cava filters: how do we move forward? Chest. 2016;149:1143-1145 [PubMed]journal. [CrossRef] [PubMed]
 
Morales J.P. .Li X. .Irony T.Z. .Ibrahim N.G. .Moynahan M. .Cavanaugh K.J. Jr.. Decision analysis of retrievable inferior vena cava filters in patients without pulmonary embolism. J Vasc Surg Venous Lymphat Disord. 2013;1:376-384 [PubMed]journal. [CrossRef] [PubMed]
 
U.S. Food and Drug Administration. Removing retrievable inferior vena cava filters: initial communication.http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm. Issued August 9, 2010; last updated May 11, 2015. Accessed August 26, 2016.
 
U.S. Food and Drug Administration. Removing Retrievable inferior vena cava filters: FDA safety communication.http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm. Issued August 9, 2010; last updated May 6, 2014. Accessed July 31, 2016.
 
Andreoli J.M. .Lewandowski R.J. .Vogelzang R.L. .Ryu R.K. . Comparison of complication rates associated with permanent and retrievable inferior vena cava filters: a review of the MAUDE database. J Vasc Interv Radiol. 2014;25:1181-1185 [PubMed]journal. [CrossRef] [PubMed]
 
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