Mrs. Miller develops a pulmonary embolus just before she is initiated on anticoagulation. Within a day of initiating anticoagulation she suffered a serious gastrointestinal bleed. Anticoagulation had to be discontinued but she is still felt to be at significant risk of another pulmonary embolus. The possibility of inserting a vena cava filter is being entertained.
Q13. When is it appropriate to use an IVC filter in the prevention of pulmonary emboli post SCI? What evidence is there for the use of an IVC filter in SCI?
1. IVC filters are appropriate when the SCI patient is at high risk of suffering a PE or reoccurrence of a PE and anticoagulation is contraindicated.
2. There is level 3 evidence that inferior vena cava filters significantly reduce the risk of pulmonary emboli in high-risk SCI patients.
Figure 9. IVC Filter Photo courtesy of Andrew Cates (2009).