Skip to main content

The Safety of Continuing Therapeutic Anticoagulation During Inferior Vena Cava Filter Retrieval: A 6-Year Retrospective Review from a Tertiary Centre

Abstract

Purpose

Assess the safety of inferior vena cava (IVC) filter retrieval in patients taking anticoagulation, compared to a non-anticoagulated cohort.

Materials and Methods

Single-centre retrospective analysis of patients who underwent IVC filter retrieval between January 2012 and February 2018. Information about patient demographics, anticoagulation, tilt, major and minor complications was collected. Major complications were defined as: IVC injury from the filter retrieval, retained fragment of filter, filter fracture and filter embolisation. Minor complications were defined as: neck haematoma and puncture site infection.

Results

Total of 357 patients (age 18–95, Male: 231) underwent IVC filter retrieval, comprising of Cook Celect Platinum, Cook Celect, and ALN-branded filters. Of these 182 patients were on anticoagulation and 175 patients were not on anticoagulation, based on the indication for the filter (thrombosis or prophylaxis) and at the discretion of the referring unit who were managing the anticoagulation. IVC filter retrieval was technically successful in 349 patients. Five major complications (1.4% of retrievals) were recorded and no minor complications (0% of retrievals). In the anticoagulation cohort, there were two major complications (1.1% of retrievals) both related to IVC injury. In the non-anticoagulated cohort, there were three major complications (1.7% of retrievals) relating to filter embolisation, IVC injury, and filter fracture.

Conclusions

IVC filter retrieval is a safe procedure with a low complication rate. Being on anticoagulation does not increase the risk of a major complication or change the management of major complication compared with a non-anticoagulated cohort. IVC filter retrieval is safe to perform in patients currently taking prophylactic or therapeutic anticoagulation based on our cohort.

Level of Evidence

Level 3, retrospective cohort study.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23):I-4–8.

    Google Scholar 

  2. 2.

    Gomez-Outes A, Terleira-Fernandez AI, Lecumberri R, et al. Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. [Review]. Thromb Res. 2014;134:774–82.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Lee M, Valenti D, de Gregorio M, Minocha J, Rimon U, Pellerin O. The CIRSE retrievable IVC filter registry: retrieval success rates in practice. CVIR. 2015;38(6):1502–7.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    NICE G. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing.  https://www.nice.org.uk/guidance/cg144/chapter/Recommendations#treatment-2 (2015). Accessed 20 June 2018.

  5. 5.

    Blebea J, Wilson R, Waybill P, Neumyer MM, Blebea JS, Anderson KM, et al. Deep venous thrombosis after percutaneous insertion of vena caval filters. J Vasc Surg 1999. 1999;30(5):821–9.

    CAS  Google Scholar 

  6. 6.

    Patel I, Davidson J, Nikolic B, Salazar J, Schwartzberg M, Walker T, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. JVIR. 2012;23(6):727–36.

    Article  PubMed  Google Scholar 

  7. 7.

    Patel I, Davidson J, Nikolic B, Salazar J, Schwartzberg M, Walker T, et al. Addendum of newer anticoagulants to the SIR consensus guideline. JVIR. 2013;24(5):641–5.

    Article  PubMed  Google Scholar 

  8. 8.

    Al-Hakim R, Kee ST, Olinger K, Lee EW, Moriarty JM, McWilliams JP. Inferior vena cava filter retrieval: effectiveness and complications of routine and advanced techniques. J Vasc Interv Radiol 2014. 2014;25(6):933–9.

    Google Scholar 

  9. 9.

    Semaan D, Esq MR, Burgin A, Harb A. Abstract No 391—Inferior vena cava filter tilt and its future clinical implications: a community based practices experience. J Vasc Interv Radiol 2013. 2013;24(4, Supplement):S166.

    Google Scholar 

  10. 10.

    Goldstein L, Adams R, Becker K, Furberg C, Gorelick P, Hademenos G, et al. Primary prevention of ischemic stroke a statement for healthcare professionals from the stroke council of the American Heart Association. Circulation. 2001;103(1):163–82.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Lee JT, Goh GS, Joseph T, Koukounaras J, Phan T, Clements W. Prolonged balloon tamponade in the initial management of inferior vena cava injury following complicated filter retrieval, without the need for surgery. J Med Imaging Radiat Oncol. 2018;62:810–3. https://doi.org/10.1111/1754-9485.12758.

    Article  PubMed  Google Scholar 

  12. 12.

    Dinglasan LAV, Oh JC, Schmitt JE, Trerotola SO, Shlansky-Goldberg R, Stavropoulos SW. Complicated inferior vena cava filter retrievals: associated factors identified at preretrieval CT. Radiology. 2013;266(1):347–54.

    Article  PubMed  Google Scholar 

  13. 13.

    Desai K, Laws J, Salem R, Mouli S, Errea M, Karp J, et al. Defining prolonged dwell time: When are advanced inferior vena cava filter retrieval techniques necessary? an analysis in 762 procedures. Circ Cardiovasc Interv. 2017;10(6):e003957.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The team would like to acknowledge the following Consultant Interventional Radiologists who were also involved in the management of these patients: Dr. Jim Koukounaras, Dr. Tim Joseph, Dr. Tuan Phan, Dr. Kelvin Stribley and A/Prof Stuart Lyon.

Funding

This study was not supported by any funding.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Warren Clements.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

For this type of study, consent for publication is not required.

Ethical Approval

Approval was obtained by The Alfred Human Research and Ethics Committee prior to performing this study.

Informed Consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kassamali, R.H., Burlak, K., Lee, J.T.L. et al. The Safety of Continuing Therapeutic Anticoagulation During Inferior Vena Cava Filter Retrieval: A 6-Year Retrospective Review from a Tertiary Centre. Cardiovasc Intervent Radiol 42, 1110–1116 (2019). https://doi.org/10.1007/s00270-019-02254-1

Download citation

Keywords

  • Interventional radiology
  • IVC filter
  • Anticoagulation
  • Complication
  • Haemorrhage