Indwelling inferior vena cava filter as a persistent thrombotic risk factor: recurrent venous thromboembolism after anticoagulation withdrawal

The use of inferior vena cava (IVC) filter is associated with long-term complications, including recurrent venous thromboembolism (VTE), particularly when filters remain indwelling. Current guidelines recommend the use of retrievable filters with removal whenever feasible. However, there is limited guidance regarding long-term anticoagulation management in patients with indwelling filters. We report the case of a 68-year-old man with an indwelling IVC filter, who developed a pulmonary embolism (PE) 3 months after completing 6 years anticoagulation for femoropopliteal deep vein thrombosis (DVT). During treatment for DVT, he had a prophylactic placement of retrievable IVC filter for a femur fracture with a high perioperative risk for VTE. Filter removal was unsuccessful. Three months after switching to extended thromboprophylaxis with sulodexide, and following a prolonged journey, he developed recurrent DVT and PE. Anticoagulation was restarted. This case highlights the potential prothrombotic role of indwelling IVC filters and the uncertainty regarding optimal anticoagulation strategies.