Evidence-based On-call

Deep vein thrombosis

Therapy

There is no clear benefit from vena caval filters combined with anticoagulation for preventing PE in high-risk patients ^a

Why?

There is an increased risk of recurrent DVT, with no clear reduction is subsequent PE. Patients with a proximal DVT, who are at high-risk for PE have fewer PE in the first 12 days, but not clearly over the next two years. Furthermore patients are more likely to have recurrent DVT. ^a

Vena caval filters in addition to anticoagulation increase recurrent DVT without clearly reducing PE

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
proximal DVT considered at high risk for PE ^a	inferior vena caval filter anticoagulation	anticoagulation	PE	4.5%	78% (-2% to 95%)	29 (15 to 320)
			symptomatic PE	6.0%	50% (-31% to 81%)	33 (-14 to 95)
			recurrent DVT	11%	-71% (-183% to -4%)	-13 (-145 to -7)