Why are IVC filters a generally bad idea?

Unlike most of my questions, this one is rhetorical. Putting an IVC filter in most patients is a sucky move. There is even a possible class action lawsuit against them.

The IVC filter began with an innocuous idea. The balance between bleeding-clotting is delicate, and one question that emerged was, what can we do to prevent DVT/PE in patients who are also at high risk of bleeding? Enter the IVC filter. Two commonly cited indications for an IVC filter is someone with a DVT with contraindication to bleeding, or prophylaxis in high-risk patients (trauma patients, for example).

There was a study conducted to determine efficacy, PREPIC, which is summed up neatly in this PulmCCM article–basically, the only evidence for reduced DVT was within 12 days of placement, and patients actually had a higher risk of recurrent DVTs in the future, without reduced mortality in the long run. Furthermore, patients with contraindication to anticoagulation were excluded from the study!

IVC filters cause complications. Chief among these is recurrent DVT. Instead of catching clots, the foreign material of an IVC filter may cause clots to form. Other possibilities include filter fracture (yes, pieces can actually break off if they’re left in long enough), filter migration, and rarely, IVC perforation with retroperitoneal bleeds. And just because an IVC filter is billed as “retrievable” does not mean that it can be easily removed. A lot of times, the filter is not removed soon enough, exposing patients to greater risk of complications.

Thus, whenever it can be shown that someone with an IVC filter doesn’t actively have a DVT/PE, they should be referred to a surgeon to have the filter removed.

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