下腔静脉过滤器预防肺动脉栓塞.docVIP

Inferior Vena Cava Filters for Prevention of Pulmonary Embolism from the?ACCP Guidelines, 9th Ed. Inferior vena cava filters should generally be placed in patients with acute pulmonary embolism PE or deep venous thrombosis DVT who have a contraindication to anticoagulation, according to the ACCP’s recommendations. The ACCP recommends against placing an IVC filter in patients with PE or DVT who are being treated with anticoagulants. Which patients with acute pulmonary embolism should receive inferior vena cava filters? The ACCP recommends?not?placing IVC filters in patients with acute PE who are being treated with anticoagulant therapy Grade 1B, strong recommendation based on moderate strength evidence . They recommend placing IVC filters in patients with acute PE who have a contraindication to anticoagulation. Grade 1B In such patients, ACCP recommends starting anticoagulation for the usual treatment period e.g., 6 months , if the patient’s risk of bleeding declines after IVC filter placement. Grade 2B The first recommendation above would seem to advise against the common practice of placing an IVC filter in certain patients with large DVTs who are felt to be high risk due to their “clot burden” and its potential for producing a life-threatening PE despite anticoagulation.?However, the intention may be more that ACCP are trying to discourage physicians from routinely treating patients with “ordinary” PEs with both anticoagulation and IVC filters. In support of this, the ACCP describes?one observational study?from an international registry that suggested IVC filter placement in patients with massive PE i.e., with hypotension was associated with a reduction in the combined endpoint of mortality and recurrent PE. At other points in the document they refer to the possibility of using IVC filters as an “adjunct to anticoagulation,” presumably in selected patients. Which patients with deep venous thrombosis DVT should receive inferior vena cava filters? The