Inferior Vena Cava Filter Placement in Patients with Venous Thromboembolism without Contraindication to Anticoagulation

• Anticoagulate hemodynamically stable patients who are admitted to the medical service with VTE and who do not have a contraindication to anticoagulation. Do not place a permanent or retrievable IVC filter.
• IVC filter placement may benefit unstable patients who may experience hemodynamic collapse with an increased PE burden. IVC filter placement should be discussed with a multidisciplinary team.
• When discharging a patient with an IVC filter, hospitalists should improve retrieval rates by scheduling subsequent removal. The discharge summary should contain information about the IVC filter, as well as clear instructions regarding the plan for removal. The instructions should include radiology follow-up information and the designation of responsible physicians in case of questions.

Although IVC filter use is increasing, the evidence does not support their use in hemodynamically stable patients who can be anticoagulated. The patient described in the initial case has no contraindication to systemic anticoagulation. Therefore, she should be started on anticoagulation, and an IVC filter should not be placed.

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Disclosures

The authors do not have any conflicts of interest to disclose