Inferior vena cava filters in patients with advanced-stage cancer

BACKGROUND: Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE). Inferior vena cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation. PATIENTS AND METHODS: A retrospective analysis of 107 cancer patients who had IVC filters inserted and followed up at our institution was performed. All patients had active cancer; a majority (> 90%) had advanced-stage disease, whereas only five patients (5.8%) had stages I or II disease. RESULTS: Eighty six patients (80.3%) had their IVC filter placed through a jugular approach. Filter insertion was not without complications; recurrent deep vein thrombosis (DVT) was reported in 10 (9.3%), PE in three (2.8%) and filter thrombosis in one patient. The value of IVC filter in patients with advanced stage disease was very limited: among 59 patients with stage IV disease for whom survival data was available, the median survival was only 1.31 months (0.92-2.20) with 23 patients (39.0%) surviving less than a month, and 40 (67.8%) surviving less than three months. CONCLUSIONS: Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or PE is high, IVC filters can be utilized. However, the placement of such filters should take into consideration the stage of disease and life expectancy of such patients. Patients with advanced-stage disease may gain little benefit from IVC filter insertion.