Efficacy and safety of cava filters in patients with an extremely high risk of venous thromboembolic complications

Introduction . In clinical practice, there are special situations when adequate anticoagulant therapy cannot be prescribed or does not prevent recurrence of PE. In such cases, the implantation of a cava filter seems to be the optimal treatment strategy, but the clinical efficacy and range of possible side effects of these devices remain unclear. Aim . To evaluate the effectiveness and safety of implantation of cava filters into the inferior vena cava for the prevention of PE. Materials and methods . The study included 530 patients with deep vein thrombosis of the lower extremities and an extremely high risk of PE in the period from 2008 to 2024. The CVF group consisted of 278 patients who had a cava filter implanted in the inferior vena cava, and the non-CVF group consisted of 252 patients who refused CVF implantation but had indications for its implantation. The primary endpoints of the study were death from any cause, confirmed PE with clinical manifestations, large or moderate bleeding, and the development of inferior vena cava syndrome. The secondary point in the CVF group was an embolism in the cava filter according to ultrasound examination. Results . There were no significant differences between the groups in terms of clinical and demographic indicators, primary endpoints. The frequency of detection of thrombotic masses in the cava filter at the hospital stage was 23 cases (8.27%). Discussion . When analyzing the Recommendations, CVF implantation in NSAIDs is recommended to be considered in special cases, however, according to the instructions of the ACCP, AHA and BSH, there are no indications for CVF implantation in all patients with DVT and/or PE who may be prescribed anticoagulant therapy. Conclusion . Any implantation of a cava filter, as a potentially unsafe device, should be carried out only after the decision of a multidisciplinary consultation.