After the FDA issued a safety warning in 2010 about adverse events associated with inferior vena cava filters, their use decreased, but the warning did not impact hospitalization rates for venous thromboembolism, according to a research letter published in JAMA Internal Medicine.
Researchers analyzed U.S. rates of inferior vena cava filter placement to determine any difference before and after the August 2010 FDA advisory, and analyzed VTE hospitalization rates to determine if change in inferior vena cava filter use was related to changes in VTE-related hospitalizations.
Satyajit Reddy, MD, from the department of internal medicine at Temple University Hospital, Philadelphia, and colleagues analyzed 1,131,274 patients in the National Inpatient Sample database who had inferior vena cava filter placement between 2005 and 2014.
The researchers found that inferior vena cava filter placement increased 22.2% between 2005 (45.2 per 100,000 U.S. residents) and 2010, the year of the FDA advisory (55.1 per 100,000 U.S. residents; P < .001).
However, placement of the devices declined between 2010 and 2014 (39.1 per 100,000 U.S. residents; P < .001).
Reddy and colleagues wrote the rate of VTE-related hospitalizations did not significantly change between 2010 (211.6 per 100,000 U.S. residents) and 2014 (211.3 per 100,000 U.S. residents).
Although some had speculated that the decline in inferior vena cava filter placements was chiefly related to decreased reimbursement due to changes in the bundling of associated Current Procedural Terminology codes that went into effect in 2012, the decline actually started 2 years earlier, after the FDA advisory, Reddy and colleagues wrote.
Another possible factor is the introduction of nonvitamin K antagonist oral anticoagulants for treatment of VTE, but its impact on inferior vena cava filter placements is not clear at this time, they wrote.
“Given the short- and long-term complications associated with [inferior vena cava filter] placement, the use of these devices should mostly be reserved for patients with an absolute indication like active bleeding,” Reddy and colleagues wrote, noting that usage remains much higher in the United States than in Europe, where the rate is less than 3 per 100,000 people. – by Erik Swain
Reddy reports no relevant financial disclosures. Another researcher reports co-founding and holding equity in Thrombolex Inc.