Vena caval filters for the prevention of pulmonary embolism

Young, Tim, Tang, Hangwi, Aukes, John and Hughes, Rodney (2007) Vena caval filters for the prevention of pulmonary embolism. Cochrane Database of Systematic Reviews, 4: . doi:10.1002/14651858.CD006212.pub4


Author Young, Tim
Tang, Hangwi
Aukes, John
Hughes, Rodney
Title Vena caval filters for the prevention of pulmonary embolism
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2007
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD006212.pub4
Issue 4
Total pages 18
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background Pulmonary emboli can have potentially fatal consequences. Inferior vena caval filters are metal alloy devices that mechanically trap
fragmented thromboemboli from the deep leg veins en route to the pulmonary circulation. Filters in current clinical use are designed to
be introduced (and in the case of retrievable filters, removed) percutaneously. Although their deployment seems of theoretical benefit,
their clinical efficacy and adverse event profile is unclear.
Objectives To examine evidence for the effectiveness of vena caval filters in preventing pulmonary embolism (PE). Secondary outcomes were
mortality, distal (to filter) thrombosis, and filter-related complications.
Search strategy We searched the Cochrane Peripheral Vascular Diseases Group Specialised Register (last searched November 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2007, Issue 4, MEDLINE (1966 to November 2007), and EMBASE (1966 to November 2007). Filter manufacturers were contacted for information.
Selection criteria Controlled clinical trials (CCTs) and randomised controlled trials (RCTs) that examined the efficacy of filters in preventing PE were
selected.
Data collection and analysis Three authors independentlyextracted information. Incidence figures were extracted from survival tables. Dichotomous outcomes were
analysed as hazard ratio estimates.
Main results One RCT was included. The PREPIC (Prévention du Risque d’Embolie Pulmonaire par Interruption Cave) trial was an open RCT
of 400 participants with documented proximal deep vein thrombosis (DVT) or PE and who received concurrent anticoagulation.
Permanent caval filters prevented PE at eight years (HR 0.37, 95% CI 0.17 to 0.79, in favour of the filter). No reduction in mortality
was seen, but this reflected an older study population (mecauses. There was an increased incidence of DVT in the filter group (HR 1.52, 95% CI 1.02 to 2.27). No details were recorded of
adverse events of filters.
Authors’ conclusions No recommendations can be drawn from the one included study in which permanent filters were used. The study lacked statistical
power to detect a reduction in PE over shorter and more clinically significant time periods. However, the PREPIC trial demonstrated
that permanent caval filters were associated with an increased risk of long term lower limb DVT.
There is a marked paucity of caval filter outcomes evidence when used within their currently approved indications. There is also a lack
of retrievable filter trials. Further trials are needed to assess vena caval filter safety and effectiveness.an age 73 years); the majority of deaths were due to cancer or cardiovascular
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article # CD006212

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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