Retrievable inferior vena cava filter utilization in obstetric patients. (17th September 2019)

• Record Type: Journal Article
• Authors: Rottenstreich, Amihai; Kalish, Yosef; Elchalal, Uriel; Klimov, Alexander; Bloom, Allan I.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 32:Number 18(2019)
• Page Start: 3045
• Page End: 3053
• Publication Date: 2019-09-17
• Subjects: Deep vein thrombosis -- inferior vena cava filter -- postpartum -- pregnancy -- pulmonary embolism -- retrievable; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2018.1456521
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objectives: The objective of this study is to evaluate patterns of use and outcomes of retrievable inferior vena cava filters (rIVCF) in obstetric patients. Methods: A single center review of consecutive patients who underwent rIVCF placement during pregnancy/postpartum in 2005–2016. A pooled analysis of the relevant cases in the English literature was conducted. Results: The current cohort comprised 24 women, median age 27 [interquartile range 24–30] years. Among 10 filters placed during pregnancy, the most common indication ( n = 4) was the need to withhold anticoagulation therapy before delivery, in the presence of acute thrombosis. In the postpartum period, most filters (64%, 9/14) were an adjunct to catheter-directed thrombolytic therapy. Inferior vena cava filters (IVCF)-related complications occurred in seven (29.2%). Retrieval was attempted in 21 patients (87.5%), and was technically successful in 19 (90.5%), for an overall removal rate of 79.1%. Pooled analysis of the literature ( n = 98) showed comparable rates for filter removal and complications (81.6%, p = .78 and 24.2%, p = .60, respectively). Suprarenal placement ( p = .12) and elective cesarean section ( p = .19) did not reduce overall complication and retrieval rates. The estimated radiation dose among pregnant patients who underwent rIVCF placement without adjunct catheter directed thrombolysis (CDT) (mean 695 Gy cm 2 ) was significantly lower than the radiation dose used in postpartum patients (1863 Gy cm 2 ) or in pregnant patients in whom adjunct CDT was utilized (4059 Gy cm 2 ) ( p = .001 for both comparisons). Conclusions: Frequent rIVCF-related complications, radiation exposure, and removal failure call for their cautious utilization in obstetric patients. The role of suprarenal placement and elective cesarean section to improve outcomes has yet to be established.