Many of my patients over the years have had an inferior vena cava filter placed, usually because of a deep venous thrombosis and a contraindication to anticoagulation. Although I was aware of the complications of these filters, I assumed that there was strong evidence for their use. From this article I have learned how thin the evidence base is for these filters.
I second the motion by the authors on the need for randomized controlled trials to determine whether the benefits of these filters exceed the risks, and I agree with the authors that such studies will occur only if the manufacturers are required by the FDA to do so to maintain their approval or funded by the federal government. Until more evidence is available, this article has changed how I will approach the next patient with a deep venous thrombosis and a contraindication to anticoagulation. Rather than “recommending” an inferior vena cava filter, I intend to discuss with the patient the lack of data on the effectiveness of the filter and the growing evidence of the harm.
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