In the Journals

IVC filter placement declining, varies by region

Prophylactic inferior vena cava filter placement declined in the United States from 2005 to 2014, but rates varied by geography, according to a research letter published in JAMA Internal Medicine.

The researchers identified inferior vena filter (IVC) filter placement in U.S. adults aged at least 18 years between 2005 and 2014 via the Nationwide Inpatient Sample, the National Inpatient Sample and the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project.

Mohammed J. Saeed, MBChB, MPH, from the divisions of infectious diseases, department of medicine, Washington University School of Medicine in St. Louis, and colleagues calculated weighted rates of IVC filter placement, and stratified patients by indication (deep vein thrombosis or pulmonary embolism) and whether they were contraindicated for anticoagulation.

IVC filter placement increased from 322.1 per 100,000 hospitalizations in 2005 to 412 per 100,000 hospitalizations in 2010, Saeed and colleagues wrote.

The placement rate dropped to 374.1 per 100,000 hospitalizations in 2011 and continued to decline to 321.8 per 100,000 hospitalizations in 2014, according to the researchers. Percentage of prophylactic IVC filter placement was reduced from 28.9% in 2005 to 22.6% in 2014.

As Cardiology Today’s Intervention previously reported: “A recent study suggested the decline is related to a 2010 [FDA] warning about filter complications,” Saeed and colleagues wrote. “That study found similar patterns of IVC filter use over time but did not analyze trends by indication.”

Among patients contraindicated for anticoagulation, the rate of IVC filter placement dropped from 188.2 1 per 100,000 hospitalizations in 2010 to 167.3 per 100,000 hospitalizations in 2014, the researchers wrote. Among patients not contraindicated, rates declined from 223.8 per 100,000 hospitalizations in 2010 to 154.5 per 100,000 hospitalizations in 2014.

The rate of DVT per 100,000 hospitalizations rose from 852.1 in 2005 to 935 in 2008, then declined to 841.3 in 2014, whereas the rate of PE per 100,000 hospitalizations rose from 719 in 2005 to 1,138.6 in 2014, Saeed and colleagues wrote.

Among U.S. regions, the mid-Atlantic had the highest rate of IVF placements per 100,000 hospital discharges in 2014 (387), with the Pacific had the lowest (251).

“The geographic variation observed is consistent with the lack of evidence supporting the use of IVC filters,” the researchers wrote. “High-quality evidence exists only for IVC filter placement in patients with [venous thromboembolism] and no contraindication to anticoagulation. ... To our knowledge, no randomized clinical trial data exist for patients undergoing IVC filter placement for VTE and a contraindication to anticoagulation or for prophylactic filter use in patients without VTE. ... Given this uncertainty, randomized clinical trials in these settings are needed.” – by Erik Swain

Disclosure: The authors report no relevant financial disclosures.

 

 

Prophylactic inferior vena cava filter placement declined in the United States from 2005 to 2014, but rates varied by geography, according to a research letter published in JAMA Internal Medicine.

The researchers identified inferior vena filter (IVC) filter placement in U.S. adults aged at least 18 years between 2005 and 2014 via the Nationwide Inpatient Sample, the National Inpatient Sample and the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project.

Mohammed J. Saeed, MBChB, MPH, from the divisions of infectious diseases, department of medicine, Washington University School of Medicine in St. Louis, and colleagues calculated weighted rates of IVC filter placement, and stratified patients by indication (deep vein thrombosis or pulmonary embolism) and whether they were contraindicated for anticoagulation.

IVC filter placement increased from 322.1 per 100,000 hospitalizations in 2005 to 412 per 100,000 hospitalizations in 2010, Saeed and colleagues wrote.

The placement rate dropped to 374.1 per 100,000 hospitalizations in 2011 and continued to decline to 321.8 per 100,000 hospitalizations in 2014, according to the researchers. Percentage of prophylactic IVC filter placement was reduced from 28.9% in 2005 to 22.6% in 2014.

As Cardiology Today’s Intervention previously reported: “A recent study suggested the decline is related to a 2010 [FDA] warning about filter complications,” Saeed and colleagues wrote. “That study found similar patterns of IVC filter use over time but did not analyze trends by indication.”

Among patients contraindicated for anticoagulation, the rate of IVC filter placement dropped from 188.2 1 per 100,000 hospitalizations in 2010 to 167.3 per 100,000 hospitalizations in 2014, the researchers wrote. Among patients not contraindicated, rates declined from 223.8 per 100,000 hospitalizations in 2010 to 154.5 per 100,000 hospitalizations in 2014.

The rate of DVT per 100,000 hospitalizations rose from 852.1 in 2005 to 935 in 2008, then declined to 841.3 in 2014, whereas the rate of PE per 100,000 hospitalizations rose from 719 in 2005 to 1,138.6 in 2014, Saeed and colleagues wrote.

Among U.S. regions, the mid-Atlantic had the highest rate of IVF placements per 100,000 hospital discharges in 2014 (387), with the Pacific had the lowest (251).

“The geographic variation observed is consistent with the lack of evidence supporting the use of IVC filters,” the researchers wrote. “High-quality evidence exists only for IVC filter placement in patients with [venous thromboembolism] and no contraindication to anticoagulation. ... To our knowledge, no randomized clinical trial data exist for patients undergoing IVC filter placement for VTE and a contraindication to anticoagulation or for prophylactic filter use in patients without VTE. ... Given this uncertainty, randomized clinical trials in these settings are needed.” – by Erik Swain

Disclosure: The authors report no relevant financial disclosures.