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Safety of Inferior Vena Cava Filter Retrieval in Anticoagulated Patients^*

^* From the Dotter Interventional Institute (Drs. Hoppe, Kaufman, Barton, Lakin, Irani, Yavuz, and Keller) and the Division of Hematology and Medical Oncology (Dr. DeLoughery), Oregon Health and Science University; and Department of Angiography (Dr. Petersen), Portland Veterans Administration Medical Center, Portland, OR.

Correspondence to: Hanno Hoppe, MD, Dotter Interventional Institute, Oregon Health and Science University, L-605, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098; e-mail: hoppeh{at}ohsu.edu

Abstract

Purpose: To evaluate the safety of inferior vena cava (IVC) filter retrieval in therapeutically anticoagulated patients in comparison to prophylactically or not therapeutically anticoagulated patients with respect to retrieval-related hemorrhagic complications.

Materials and methods: This was a retrospective study of 115 consecutive attempted IVC filter retrievals in 110 patients. Filter retrievals were stratified as performed in patients who were therapeutically anticoagulated (group 1), prophylactically anticoagulated (group 2), or not therapeutically anticoagulated (group 3). The collected data included anticoagulant and antiplatelet medications (type, form and duration of administration, dosage) at the time of retrieval. Phone interviews and chart review was performed for the international normalized ratio (INR), activated partial thromboplastin time, platelet count, infusion of blood products, and retrieval-related hemorrhagic complications.

Results: Group 1 included 65 attempted filter retrievals in 61 therapeutically anticoagulated patients by measured INR or dosing when receiving low-molecular-weight heparin (LMWH). Four retrievals were not successful. In patients receiving oral anticoagulation, the median INR was 2.35 (range, 2 to 8). Group 2 comprised 23 successful filter retrievals in 22 patients receiving a prophylactic dose of LMWH. Group 3 included 27 attempted filter retrievals in 27 patients not receiving therapeutic anticoagulation. Six retrievals were not successful. Five patients were receiving oral anticoagulation with a subtherapeutic INR (median, 1.49; range, 1.16 to 1.69). No anticoagulation medication was administered in 22 patients. In none of the groups were hemorrhagic complications related to the retrieval procedures identified.

Conclusions: These results suggest that retrieval of vena cava filters in anticoagulated patients is safe. Interruption or reversal of anticoagulation for the retrieval of vena cava filters is not indicated.

Key Words: pulmonary embolism • vena cava filters • venous thrombosis