Inferior vena cava filters have increasingly been used in patients with acute venous thromboembolism over the past 3 decades, despite a lack of long-term data on their benefits and risks. A new randomized, open-label, blinded end point trial called PREPIC2 has shown that placement of a retrievable inferior vena cava filter for 3 months provides no clinical benefit in patients with acute symptomatic pulmonary embolism who are receiving anticoagulation for ≥6 months.

The rate of recurrent pulmonary embolism was similar for the two treatment groups at both the 3-month (3.0% vs 1.5% for controls; P = 0.50) and 6-month (3.5% vs 2.0% for controls; P = 0.54) follow-up. The rates of recurrent deep vein thrombosis, major bleeding, and all-cause death also did not differ significantly between the two groups at either timepoint. Access site haematomas, filter thrombosis, and retrieval failure due to mechanical reasons occurred in 2.6%, 1.6%, and 5.7% of patients who received a filter, respectively.

The PREPIC2 investigators conclude that their study findings do not support the use of a retrievable inferior vena cava filter in patients who can be treated with anticoagulation. “We believe that the low rate of events observed in the control group ... [indicate] that modern management with full-dose anticoagulation therapy is likely [to be] very effective even in patients usually considered to be at high risk for recurrence,” write the investigators, “rendering unnecessary additional therapy such as inferior vena cava filters.”