Quote:
Originally Posted by cardinalohio
My husband has been on Warfarin since 1990. It is well regulated. His INR kept between 2 & 3. He asked today at his Dr visit about a Greenfield filter. The Dr said they are not recommended and in his case not needed.
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I worked in the UK as a Clinical Nurse Specialist in anticoagulation care- ie we managed over 7,000 patients requiring warfarin and/or Low molecular weight heparin for DVT and PE.
Some were life long after having several episodes of DVT, maybe due to inherited thrombophylias, cancer etc.
Others required LMWH during pregnancy, followed by warfarin after delivery for 3-6 months.
After eading this thread I was slightly puzzled as to why people who had had a single episode of DVT/PE, maybe due to factors such as surgery or pregnancy were sitting around with lifelong VCFs in, and appeared never to have been anticoagulated with warfarin.
I did some research and found that the evidence from clinical trials for the use of Vena Caval filters is very limited, but what evidence there is shows that
1. Unless there is a HUGE contraindication to anticoagulation, in most cases VCF insertion should only be considered if anticoagulation has failed ie pt has a repeated episode of DVT/PE whilst therapeutically anticoagulated ie INR within therapeutic range of 2-3 (usually)
2. There is some evidence to suggest that VCFs without the addition of warfarin can lead to clot formation (around the filter) compared to patients treated with VCF and warfarin therapy or with warfarin alone.
3. The VCF isn't going to protect against DVT -which is where the majority of PEs originate. Warfarin will do that.
In those that really do require a lifelong VCF (and this is where there really is lack of evidence) the addition of warfarin should be considered.
4studies showed an increased number of DVTs (almost twice as many) in VCF alone, compared to pts who were anticoagulated, however the incidence of PE may be lower in the VCF group.(different studies had different results, presumably due to recruitment of pts with different case scenarios)Most importantly, there was no difference in mortality between the 2 groups.
5. VCFs require periodic monitoring (pref' by the person who inserted it). They can move! For some removable devices there is a limit to how long after insertion they can be removed
Seems to me that sticking the VCF in may be a convenience/cost choice, which may or may not have been discussed with the patient.
Warfarin, however costs pennys, but the monitoring costs need to be considered.
Also, warfarin can be a dangerous drug if it's not monitored and dosed correctly, and patients don't follow the do's and don'ts, but if it's done well, it works well!
Maybe it's easier to stick a VCF in and forget about it, even though it may not be required or useful anymore.
Here's a link to the most up to date guidelines from the British Clinical Standards in Haematology (the guidelines we followed as CNS as haematologists manage DVT/PE patients longterm in the UK)
Lots of medical jargon-sorry, but at least it's backed by evidence from the limited research there is.
Happy to try and answer any questions if I can!
http://www.bcshguidelines.com/docume...s_bjh_2006.pdf
Also from the (US) Society of Interventional Radiology
http://www.sirweb.org/misc/Guidelines_filters.pdf
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[SIZE=3]1. The primary means of therapy and prophylaxis of VTE are pharmacologic[/SIZE]
Moderator cut: too long a quote, 1-2 sentences and link please 
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