Vena cava filter retrieval in therapeutically anticoagulated patients.

Abstract

BACKGROUND:

Vena cava filters (VCFs) are indicated in patients with active venous thromboembolism and are a contraindication to therapeutic anticoagulation. When patients can be anticoagulated, VCFs can be removed; however, patients often have anticoagulation discontinued during the retrieval procedure, leaving them at risk for pulmonary embolism (PE). The authors evaluated their experience with retrieving VCFs in therapeutically anticoagulated patients.

METHODS:

Data from a prospectively collected database of patients with VCFs placed between January 2005 and September 2007 were reviewed. The retrievals in therapeutically anticoagulated patients (international normalized ratio, 2.0-3.4) were performed using a strict protocol, including preretrieval and postretrieval cavograms. All retrievals were performed in the operating room, and patients were discharged home the same day and examined within 7 to 14 days. Descriptive statistics including means and counts were calculated.

RESULTS:

One hundred thirteen VCF removals occurred during the study period; 62 were attempted on anticoagulated patients (42 male and 20 female patients; mean age, 36.5 years). Thirty-five patients (56%) had VCFs placed for prophylaxis, 22 (35%) had deep venous thromboses or PEs but had contraindications to anticoagulation, and 5 (8%) were on anticoagulation, which was discontinued perioperatively for major surgical operations. The mean time the filters were in place was 153.7 days (range, 22-684 days). No extravasation was seen on postretrieval cavography. Eight of 62 removal attempts in anticoagulated patients were unsuccessful. One patient had a postoperative pneumothorax that was successfully managed without intervention. There were no operative bleeding complications, and no hematomas or contusions were seen at follow-up.

CONCLUSIONS:

The retrieval of VCFs in therapeutically anticoagulated patients can be performed without complication. Given the perioperative risk for PE, anticoagulation should not be discontinued for VCF retrieval.

• Authors: Thomas M Schmelzer, A Britton Christmas, Dennis A Taylor, B Todd Heniford, Ronald F Sing
• Journal: American journal of surgery (Am J Surg) Vol. 196 Issue 6 Pg. 944-6; discussion 946-7 (Dec 2008) ISSN: 1879-1883 [Electronic] United States
• PMID: 19095114 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anticoagulants

Topics

• Adolescent
• Adult
• Aged
• Anticoagulants (therapeutic use)
• Blood Coagulation (drug effects)
• Device Removal (methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Pulmonary Embolism (blood, prevention & control)
• Treatment Outcome
• Vena Cava Filters
• Young Adult