Inferior Vena Cava Filters in Patients with Cancer
The placement of an inferior vena cava filter is understudied in patients with cancer and clear guidelines do not exist.
Venous thromboembolism (VTE) represents a common complication that patients with cancer face. Approximately 1% to 8% of patients with cancer will develop VTE, representing a nearly 50 times increased risk compared with the general population.1
Once a cancer diagnosis is established, those patients with metastatic disease can have up to a 13-times higher incidence of VTE when compared to patients with only local disease.1
Patients with cancer are at increased risk of developing a VTE based on their relatively prothrombotic state. Many patients with cancer also have to undergo surgical procedures, which can further increase their risk of VTE.2
Once diagnosed with VTE, there are several treatment options available including full-dose anticoagulation (ATC) as well as the placement of an inferior vena cava filter (IVCF).
When an IVCF is placed, there are two main types: potentially retrievable and permanent.1 The new development of potentially retrievable IVCFs have led to their increased utilization in the last decade.
According to current guidelines, an IVCF is only indicated when patients experience recurrent pulmonary embolism (PE) despite full dose ATC or when therapeutic ATC is contraindicated.1,2,3
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However, an IVCF is commonly considered in patients with cancer based on their relative increased risk of recurrent VTE and PE and potential contraindications to full dose ATC including intracranial metastases, established gastrointestinal bleeding or planned procedures.4
In addition, many oncology health care professionals are concerned that although their patients may not have contraindications to full dose ATC upon their initial VTE diagnosis, they may develop contraindications in the future and therefore request an IVCF. Some clinicians will consider the placement of a prophylactic IVCF in a patient with cancer without a prior VTE.