Efficacy and safety of direct oral anticoagulants in patients with implanted inferior vena cava filters: a systematic review and meta-analysis

Nowadays, vitamin K antagonists (VKA) remain the anticoagulants of choice for patients with implanted inferior vena cava (IVC) filters, while the use of direct oral anticoagulants (DOACs) is controversial. Aim of the review – the study aimed to compare the efficacy and safety of DOACs and VKAs in patients with IVC filters. A systematic search for the relevant papers was performed in Medline (Pubmed) and the Cochrane Library according to the PRISMA guidelines. The inclusion criteria for the analysis were as follows: comparative studies of any design that enrolled patients with verified venous thromboembolism (VTE) who underwent IVC filter implantation and received long-term therapy with DOACs or VKAs with reported numbers of thrombotic and hemorrhagic complications within a follow-up of ≥3 months. The primary endpoints were VTE recurrence and major bleeding. Secondary endpoints included deep vein thrombosis (DVT), IVC thrombosis or filter occlusion, pulmonary embolism (PE), clinically relevant non-major (CRNM) bleeding, any bleeding, and all-cause mortality. Meta-analysis was performed using a random or fixed-effect model depending on the identified heterogeneity. As a result of the literature search was performed in July 2024 and identified 189 references, of which four articles were selected for full-text analysis after screening and excluding 174 irrelevant papers. The final qualitative analysis and quantitative synthesis included two retrospective cohort studies of 302 patients comparing rivaroxaban and warfarin. There were no significant differences between rivaroxaban and warfarin according to the prespecified endpoints. Rivaroxaban is the only DOAC studied in patients with IVC filters. Anticoagulation with rivaroxaban is not less effective and safe than with warfarin after IVC filter implantation.