Therapies to prevent pulmonary embolism (PE)

Anticoagulant therapy

Anticoagulation medications (blood thinners) are the most common first option to prevent PE. These work by slowing or eliminating the formation of threatening blood clots that could travel to the heart or lungs as PE. Anticoagulation medications may be delivered in several ways: orally (by mouth) from a pill or by injection into a vein (intravenously) or under the skin (subcutaneously) through a needle. Since anticoagulation medications thin blood, patients bleed more easily. Likewise, there are certain situations where anticoagulation medications are not recommended to be used (at least temporarily) or may not work. For instance, if you are at an increased risk of bleeding your doctor may consider placement of a vena cava filter.

Inferior vena cava (IVC) filter

The inferior vena cava is the main vessel that returns blood from the lower half of your body to your heart.

An IVC filter is a medical device that doctors can place in your IVC. Physicians have used IVC filters for more than 40 years to help prevent PE. IVC filters are an option for PE prevention, especially if you have already had a PE.

An IVC filter does not stop blood clots from forming. These devices are cage-like and usually cone-shaped. They are designed to catch blood clots as they travel through the IVC and prevent the clots from reaching your lungs. Blood continues to flow around and through an IVC filter.

IVC filters are often placed if blood-thinning medication cannot be used or was not effective. Some IVC filters are designed to be permanent implants, and some filters have the option to be removed after the risk of PE has passed.

You should not receive a filter if any of the following statements are true:

Your doctor tells you that your IVC diameter is not the right size for a filter.
You are at risk of septic embolism (a type of blood vessel blockage that can occur when pus-forming bacteria or other infectious organisms are in the bloodstream).
There is so much clot present in the vein that your doctor is not able to pass a catheter through it safely.

IVC filters should not be removed if:

Your doctor determines that you are still at risk of PE and you cannot take anticoagulation medication.
More than 25% of the space inside your filter contains trapped blood clots. Even if this happens, your filter is designed to continue to trap clots while still allowing for blood to flow through the IVC.
Your doctor decides that the risks of removing your filter are greater than the risks of leaving the filter in place.

Procedure Information

The IVC Filter Implantation Procedure

The filter starts out compressed like a tiny umbrella so that it will fit through a catheter. While you are under anesthesia (most commonly conscious sedation), your doctor will insert the catheter into your body at either the jugular vein in the neck or the femoral vein in the thigh. This is referred to as a “minimally invasive procedure.”

While your doctor is watching under x-ray, the catheter containing the IVC filter is guided into position within your IVC. Once in the proper location, your doctor will release the IVC filter from the catheter. The IVC filter will spring open and stay in place with fixed hooks that attach onto the inner layer of the IVC.

The Filter Retrieval Process

Retrievable filters are designed with a hook on one end so doctors can capture and remove them. To retrieve an implanted filter, a small needle is inserted through the skin and into the jugular vein at the neck (this is also performed under conscious sedation or general anesthesia). A retrieval snare inside a catheter will be used to remove your IVC filter. During retrieval, your doctor will move the snare forward out of the catheterto connect the IVC filter’s hook.

Once the IVC filter has been engaged by the retrieval snare, your doctor will pull the filter back inside the catheter. The IVC filter compresses down as it enters the catheter. When fully compressed, the catheter and IVC filter inside are pulled safely through the blood vessel and out of your body.

Important Follow-Up after IVC Filter Implantation Procedure

Removing filters after the risk of PE is gone
Sometimes, after the risk of PE is gone, your doctor might decide to remove your IVC filter. Some filters are designed with the option to be retrieved, and others are designed to be permanent only. Ask your doctor which type of filter you have.

After the risk of PE is gone, your doctor might decide to retrieve your filter after just a few days or weeks. In other cases, it might be several months before it is retrieved, or it may not be removed at all.

When should a filter be left in place?
Some patients should not have their filters removed. For example, if more than 25% of the space inside your filter contains trapped blood clots. Your IVC filter is designed to trap clots while still allowing blood to flow through your IVC.

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Therapies to prevent pulmonary embolism (PE)

Anticoagulant therapy

Inferior vena cava (IVC) filter

Procedure Information