Is Your Blood-Clot Filter Overstaying Its Welcome?

When its work is done, filter may do more harm than good

Blood-Clot

A blood clot in the right place — say, at the site of a cut — can save your life. But a blood clot in the wrong place — in the lungs, for example — can be deadly.

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That’s why doctors take extra measures to prevent unwanted blood clots when you’re at risk of deep vein thrombosis or pulmonary embolism.

For some people, blood-thinning drugs are not an option. However, a tiny filter placed in a vein below the kidneys can provide them with protection. These devices are called inferior vena cava filters, or  IVCFs.

Although IVCFs do a great job, they have risks of their own. And those risks multiply if the filters are left in place longer than they’re needed.

“Follow-up is often poor because the doctor who inserts the IVCF may not be the one who takes care of the patient,” says John R. Bartholomew, MD, Section Head of Vascular Medicine in Cleveland Clinic’s Miller Family Heart & Vascular Institute. “So care is not properly coordinated.”

Trade-off of risks and benefits

Most patients on blood thinners are evaluated after three months. If the reason for the first clot was known, and a second clot has not occurred, the medication is usually stopped.

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Patients with an IVCF should be treated the same way, says Dr. Bartholomew.

“One of their treating doctors needs to decide whether the filter should come out — and, if so, when,” he says.

Most IVCFs implanted today are intended for short-term use, although they can be left in the body permanently if necessary.

If they are not removed when they are no longer needed, however, the risks begin to outweigh the benefits. In rare cases, the filter can migrate up the vein, break apart, and perforate the vein or cause blood clots to occur.

That’s why they shouldn’t be forgotten.

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Time to take stock at 3 months

At Cleveland Clinic’s IVC Filter Retrieval Clinic, patients with IVCFs are evaluated to determine whether their filters should be removed or left in place.

“At the time a filter is being put in, the doctor should make sure you have a follow-up appointment in two or three months. You also need a plan for when the filter should be removed,” says Dr. Bartholomew.

“If you’ve had a filter for more than three months and have not been evaluated, tell your doctor right away.”

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