Shouldn't we put an ICV filter in everyone with a DVT?

[noyesno, MSN, APRN, NP]

I know DVT's are treated with anticoagulants. They keep clots from getting bigger and prevention new clots from forming, blah, blah, blah. I also know that DVT's eventually disappear on their own.

Questions I keep getting include, "how long until the clot disappears?" and "what's keeping the clot from dislodging and becoming an embolism?"

Shouldn't we put IVC filters in everyone with a DVT? Those only seem to be used when anticoagulation is contraindicated.

Any insight homies?

[nurseprnRN, BSN, RN]

1) It varies

2) Nothing

The only time you should use Wikipedia is to see if there are real references, and you look at those. Looking for "Greenfield filter" I found this there:

An inferior vena cava filter (IVC filter) is a type of vascular filter, a medical device that is implanted by interventional radiologists or vascular surgeons into the inferior vena cava to presumably prevent life-threatening pulmonary emboli (PEs).^[2] Their effectiveness and safety profile is not well established, and in general, they are only recommended in some high-risk scenarios.^[2]

In 2012, the American College of Chest Physicians recommended IVC filters for those with contraindications to anticoagulation who either have acute PE or acute proximal (above the knee) deep vein thrombosis (DVT).^[3][4]

• ^{^ Gunther Tulip IVC Filter. Cook Medical. URL:} http://www.cookmedical.com/di/di_front/images/dif_bu1.jpg. ^{Accessed on: November 24, 2007.}
  
• ^{^} a b c ^{Young T, Tang H, Hughes R (2010). Young, Tim. ed. "Vena caval filters for the prevention of pulmonary embolism". Cochrane Database Syst Rev (2): CD006212.} doi^:10.1002/14651858.CD006212.pub4^. PMID 20166079^.
  
• ^ Guyatt ^{et al. 2012, p. 21S: 2.13.2.}
  
• ^ Guyatt ^{et al. 2012, p. 24S: 5.9.2.}
  

• Guyatt, GH; Akl EA; Crowther M; et al. (2012). "Executive Summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest 141 (suppl 2): 7S–47S. doi:10.1378/chest.1412S3. PMID 22315257.
  

• Athanasoulis, Christopher A, MD. "Complications of Vena Cava Filters". Journal of Radiology. 3 188: 614–615. Retrieved 10/11/2012.
  

[Rose_Queen, BSN, MSN, RN]

It involves a weighing of risks and benefits. Placing an IVC filter isn't without risks- you could perforate a vascular structure, there's x-ray exposure involved, risk of causing a hematoma at the insertion site. There needs to be some sort of selection criteria, not just willy-nilly inserting IVC filters into every patient with a DVT. That said, in my facility pretty much every trauma patient who is non-ambulatory and in ICU long-term gets a prophylactic IVC filter, without waiting for a DVT to develop. Generally, in those cases the benefit of placing the filter outweighs the risks of waiting for something to happen. As with everything, selection criteria may change. It used to be that the only option was a permanent filter that stayed put forever; there are some options on the market now that can later be removed. Again, weighing of risks and benefits when removing as well.