Abstract

A short cut review was carried out to establish whether inferior vena cava filters were better than standard anticoagulation therapy in reducing pulmonary emboli in patients with proximal vein lower limb DVTs. Altogether 463 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

Clinical scenario

A 40year old man attends the emergency department with a one week history of a painful, swollen right leg. An illeo-femoral deep vein thrombosis is diagnosed. He has no previous history of venous thromboembolism, however, his father has a history of PE. You decide to give him standard anticoagulation therapy. A passing physician states that the patient is at high risk for developing a PE, and suggests referral for insertion of an inferior vena cava filter. You wonder if there is any evidence to support this assertion.

Three part question

In [patients with proximal lower limb DVT] are [inferior vena cava filters better than standard anticoagulantion therapy] at [reducing pulmonary embolisation and minimising recurrence of DVT]?

Search strategy

Medline 1966-01/04 using the Ovid interface. [exp venous thrombosis/OR deep vein thrombosis.mp OR DVT.mp OR exp deep vein thrombosis OR deep venous thrombo.mp] AND [exp vena cava filters/OR inferior vena cava filters.mp OR IVC$.mp] LIMIT to human and English.

Search outcome

Altogether 463 papers were found of which one was a PRCT relevant to the question (see table 4).

Comment(s)

The authors conclude that any initial beneficial effects of the filter group were counter balanced by the increased rate of recurrent DVT, without any significant difference in mortality. There is only one RCT to be found in the literature addressing this question, while there is an abundance of literature supporting the use of anticoagulants as effective treatment for proximal DVT.

CLINICAL BOTTOM LINE

Standard anticoagulants are the first treatment of choice for someone with a proximal DVT who has no contraindications to the treatment.