August 11, 1997

Indications for Inferior Vena Cava Filters-Reply

Author Affiliations

Tours, France

Arch Intern Med. 1997;157(15):1771. doi:10.1001/archinte.1997.00440360216030

We have reported a 3.3% rate of recurrent pulmonary embolism (PE) in patients with free-floating proximal deep venous thrombosis treated with conventional anticoagulation.1 However, as Galus points out, patients who were suffering from acute massive PE and who were treated with thrombolytic drugs were excluded from the trial. Are these patients at higher risk of having PE recurrences during and immediately after thrombolysis? Should a filter be placed in the inferior vena cava before lysis in such conditions? To my knowledge, controlled trials have never been performed to address these 2 points. Because the results of the Eurokinase Pulmonary Embolism Trial2 have shown no increased risk of recurrences in patients suffering from acute PE treated with urokinase as compared with patients treated with heparin, we have not recommended the placement of inferior vena cava filters before lysis. Moreover, venous investigations are not routinely performed before the initiation of thrombolytic

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