Inferior vena cava filters for the cerebrovascular patient

Acute cerebrovascular disease is often complicated by deep venous thrombosis and pulmonary embolism. Many of these patients are at high risk of intracranial hemorrhage with therapeutic anticoagulation. These patients may benefit from insertion of inferior vena cava filters. Studies specifically dealing with stroke patients are lacking, but it is the authors' opinion that filters reduce the incidence of pulmonary embolism. There is little evidence to support the use of these devices prophylactically in patients who do not have venous thromboembolism. Retrievable filters are an attractive option but there are concerns about their safety; and if regularly used, a system for successful filter retrieval in all patients should be instituted. The role of concurrent anticoagulation with filters is not clear. However, we believe anticoagulation, in the absence of a contraindication, is beneficial in patients with active venous thromboembolism.