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Safety of IVC Filter Retrieval without Interruption of Anticoagulation
Neil Moudgill, MD, Bing Shue, BS, Paul DiMuzio, MD, Taki Galanis, MD, Atul Rao, MD, Joshua Eisenberg, MD.
Thomas Jefferson University, Philadelphia, PA, USA.
Objectives:
The purpose of this study is to examine the safety of IVC filter retrieval in patients receiving anticoagulation. Current guidelines recommend bridging anticoagulation for patients undergoing IVC filter retrieval. However, the safety of IVC filter retrieval in patients receiving therapeutic anticoagulation has not been adequately assessed.
Methods:
Retrospective review of a prospectively-entered database identified fourteen patients with fifteen filters (one patient with duplicated IVC and two filters) receiving therapeutic anticoagulation therapy immediately prior to IVC filter retrieval. Therapeutic anticoagulation was defined as 1 mg/kg/day dosing with Enoxaparin or an International Normalized Ratio (INR) > 2.0 with warfarin therapy. Data points collected included 1) type, dosage and duration of anticoagulation, 2) occurrence of post-operative hemorrhagic complications, 3) need for postoperative blood transfusion, 4) location of venous puncture, and 5) INR, Prothrombin time, and Partial thromboplastin time.
Results:
Prior to filter retrieval, all patients were receiving therapeutic anticoagulation and no adjustments were made to the anticoagulation regimen preoperatively or postoperatively. Of those taking warfarin (n= 10), the average pre-operative INR was 2.37 (range1.78-3.07). In the fourteen patients, there were a total of twelve internal jugular punctures and four femoral punctures performed. One patient received a femoral puncture after an unsuccessful attempt to access the IVC through an internal jugular approach. Twelve filters were retrieved successfully; three attempts were unsuccessful secondary to technical limitations at the time of retrieval. One patient had a duplicated IVC requiring 2 filters, only one of which was retrieved. In two other patients, the filter was adhered to the cava and could not be captured. There were no observed postoperative hemorrhagic complications and no postoperative blood transfusions were required in any of the cases.
Conclusions:
This study suggests that it is safe to remove IVC filters in patients receiving therapeutic anticoagulation without cessation or adjustment of the anticoagulation regimen. The advantages of such an approach include simplicity, cost savings, and protection from recurrent VTE.
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