INDICATIONS FOR PLACEMENT OF IVC FILTERS IN BARIATRIC SURGERY PATIENTS Routine use of some form of prophylaxis for DVT

T here has been a change in the indications for inferior vena cava (IVC) filter placement. In the earliest reports of filter use, the majority of filters were placed because of the failure of anticoagulation to prevent pulmonary embolism (PE).1 Now, more than half of filters are placed prophylactically for the prevention of PE.2 Not only are filters being placed for prophylaxis against PE in patients with known deep vein thrombosis (DVT), but filters are also being used in patients who are only at risk of developing a thromboembolic event. There are three main conditions for which filters are being placed prophylactically for this indication. Neurosurgical patients, especially those with paralysis, are at particularly high risk for PE and are often not able to be anticoagulated because of the risk of intracranial hemorrhage. Second, many trauma centers have adopted policies of prophylactic IVC filter placement in high-risk patients, such as those who are immobile, or are at risk for bleeding complications, or are unable to be screened with ultrasound for DVT due to their injuries. Langan et al have shown a significantly reduced incidence of PE in those high-risk trauma patients who have undergone prophylactic filter placement.3 Last, obese patients undergoing surgery are at substantial risk for developing thromboembolic disease. The increasingly important role of surgical therapy for treating the morbidly obese has brought more relevance to the issue of prophylaxis for PE in this patient population. The introduction of retrievable IVC filters may perpetuate the increased use of filters for prophylaxis. This is particularly true in patients with a short, defined period of increased risk for thromboembolic disease. IVC Filter Placement in Bariatric Patients