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Editorials: Point and Counterpoint |

POINT: Do the Benefits Outweigh the Risks for Most Patients Under Consideration for Inferior Vena Cava Filters? Yes

Brian Funaki, MD; Ziv J. Haskal, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: B. F. is on the Data Safety Monitoring Committee for Novate and the SENTRY Trial; and Z. J. H. does consulting and is on the speakers bureau at Penumbra, WL Gore, and CR Bard.

aVascular and Interventional Radiology, Department of Radiology, University of Chicago Medicine, Chicago, IL

bDepartment of Radiology and Medical Imaging/Interventional Radiology, University of Virginia School of Medicine, Charlottesville, VA

CORRESPONDENCE TO: Brian Funaki, MD, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medicine, 5840 S Maryland, MC 2026, Chicago, IL 60637


Copyright 2016, . All Rights Reserved.


Chest. 2016;150(6):1181-1182. doi:10.1016/j.chest.2016.08.1481
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Extract

It is logical that an inferior vena cava (IVC) filter can catch clots—like a pasta chef draining noodles through a colander. We have seen them catch these clots, thank goodness. Studies have characterized the comparative clot trapping efficacies of caval filters; however, there are few randomized prospective studies comparing caval filtration with no therapy. Given decades of research, would a patient with DVT and a contraindication to anticoagulation wish to be randomized to the nonfilter group? “Sir, begin your skydive. You may have a parachute in your pack…or a pair of shoes. Pull the ripcord and see.” Therefore, the paucity of controlled trials of filter vs no filter is not surprising. Withholding a relatively benign acute intervention—having a filter placed, is challenging. That said, we readily acknowledge the need to remove filters when this protective value fades. The better question is not, “do filters work?” but rather, “whom do they best help—and for how long?”

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